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PubMed2001

Ankle joint injuries as a reconstruction parameter in car-to-pedestrian accidents.

The study has assessed the usefulness of ankle joint injuries for deducing about the presumable location of a pedestrian in relation to a motor vehicle at the moment of collision. A statistically significant correlation was found between the direction of impact and the mechanism of ankle joint injuries. Such injuries were found in 113 of 317 pedestrian, fatal victims of road traffic accidents (36%). In the cases of impacts on the medial surface of the lower limb, the injuries associated with the supination mechanism were six times more frequent than the injuries associated with the pronation mechanism, while in the group of impacts on the limbs from the lateral side those connected with the pronation mechanism were four times more frequent. In victims hit from the back, the injuries connected with the plantarflexion mechanism were found almost four times more frequent than the dorsiflexion mechanism and in victims hit from the front in three of the five damaged joints the dorsiflexion component was observed (without any plantarflexion case). Less frequent "pronation injuries" in the limbs hit from the medial side and "supination injuries" in the limbs hit from the lateral side as well as "dorsiflexion injuries" in victims hit from the back predominantly occurred in impacts to the pelvic area, i.e. resulting from collisions with a van or lorry. Injuries of upper ankle joints are, thus, useful for reconstructing the presumable location of the pedestrian in relation to the vehicle at the moment of collision, especially, when the vehicle involved in the accident is known.

Accidents, Traffic↗
PubMed1979

[Ossifications of soft parts after operative treatment of luxation fractures of the ankle joint (author's transl)].

Operative treatment of luxation fractures of the ankle joint has caused a drop in poor late results, to one-quarter of the total number of patients compared with about one-half with the conservative procedure. Part of the unsatisfactory results is caused by ossifications in region of the interosseous membrane and tibiofibular syndesmoses. The incidence of such ossifications within a closed series of 200 own operatively treated cases was examined and pathogenetic factors were discussed. Further improvement of the treatment results of ankle joint fractures appears possible via subtle operation technique and omission of routine application of fixation screws for safeguarding lesions of the syndesmoses.

Ankle Injuries↗
PubMed2001

Knee joint mobilization reduces secondary mechanical hyperalgesia induced by capsaicin injection into the ankle joint.

Joint mobilization is a treatment approach commonly used by physical therapists for the management of a variety of painful conditions. However, the clinical effectiveness when compared to placebo and the neurophysiological mechanism of action are not known. The purpose of this study was to establish that application of a manual therapy technique will produce antihyperalgesia in an animal model of joint inflammation and that the antihyperalgesia produced by joint mobilization depends on the time of treatment application. Capsaicin (0.2%, 50 microl) was injected into the lateral aspect of the left ankle joint and mechanical withdrawal threshold assessed before and after capsaicin injection in Sprague-Dawley rats. Joint mobilization of the ipsilateral knee joint was performed 2 h after capsaicin injection for a total of 3 min, 9 min or 15 min under halothane anaesthesia. Control groups included animals that received halothane for the same time as the group that received joint mobilization and those whose limbs were held for the same duration as the mobilization (no halothane). Capsaicin resulted in a decreased mechanical withdrawal threshold by 2 h after injection that was maintained through 4 h. Both 9 and 15 min of mobilization, but not 3 min of mobilization, increased the withdrawal threshold to mechanical stimuli to baseline values when compared with control groups. The antihyperalgesic effect of joint mobilization lasted 30 min. Thus, joint mobilization (9 or 15 min duration) produces a significant reversal of secondary mechanical hyperalgesia induced by intra-articular injection of capsaicin.

Animals↗
PubMedDate not supplied

Arthroscopic arthrodesis of the ankle joint.

SUMMARY: The authors report on 15 cases of arthrodesis of the ankle joint performed by operative arthroscopy. The follow-up ranges from 1 to 3 years, and 100% of the ankle joints achieved fusion at an average of 11.5 weeks. Two of the patients had some hindfoot pain, probably because of degenerative changes to their subtalar joints, even with this short follow-up. Five patients required further surgical treatment to correct complications related to infection, symptomatic hardware, or subtalar joint arthritis. Although the fusion rate is certainly encouraging, this procedure in the senior author's hand has a significant complication rate.

Adolescent↗
PubMed1989

The organization of heterogenic reflexes among muscles crossing the ankle joint in the decerebrate cat.

1. Mechanical actions of heterogenic (intermuscular) reflexes arising from proprioceptors in flexor and extensor ankle muscles were measured in intercollicular and premammillary decerebrate cats. Length inputs were applied to the freed tendons of one of a pair of muscles crossing the ankle joint and resulting changes in force in both muscles were measured. Interactions between autogenic and heterogenic reflexes were studied by applying length changes to both muscles. 2. A consistent asymmetry was observed in the heterogenic inhibition between the single-joint antagonists soleus and tibialis anterior (TA). Inhibition from soleus to TA was weak or absent during the reflex activation of TA. In contrast, a strong heterogenic inhibition was consistently observed from TA to soleus during the activation of soleus by a crossed-extension reflex. The effect of this inhibition in the intact joint is to increase the apparent mechanical stiffness of soleus. 3. Mutual synergism among soleus, medial gastrocnemius (MG) and lateral gastrocnemius (LG) was demonstrated only at low to moderate forces by the observation of excitatory reflexes among them. During a naturally or electrically evoked crossed-extension reflex, however, a unidirectional inhibitory reflex from MG and LG to soleus was observed. This inhibition increased with force in MG or LG. These results suggest that the knee and ankle joints become more tightly linked mechanically at high forces since the stiffness of the biarticular gastrocnemius muscle predominates over that of the uniarticular soleus. 4. Under quiescent conditions (no resting muscle activation), mutual synergism was obeyed among the ankle extensors soleus, LG and MG and also between the pretibial flexors TA and extensor digitorum longus (EDL). Moreover, inhibition was generally observed between a pretibial flexor and an ankle extensor. Departures from this expected pattern of heterogenic reflexes occurred when the muscle groups were activated by crossed-extension and flexion reflexes. Reflexes onto soleus, TA and EDL reversed in sign or increased in magnitude. 5. The observed patterns of reflex connectivity among the ankle flexors and extensors were similar in both intercollicular and premammillary preparations, although changes in reflex strength were sometimes noted in cases where a second, lower transection was performed during the experiment. 6. It is argued from the large magnitudes of certain heterogenic reflexes that the mechanical response properties of muscles crossing the ankle joint in the intact animal are not dominated by autogenic reflexes and intrinsic mechanical properties.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1992

[Arthrodesis of the upper ankle joint. Indications, technique, results].

From 1984 to 1990 a total of 119 arthrodesis of the upper ankle joint were performed at the Hospital of Accident Surgery of the Trade Association in Frankfurt am Main. The results of 98 patients after an arthrodesis of the upper ankle joint are documented by an x-ray control series and patient files, including the expertise on the medical status of pensioners plus a follow-up examination of 34 patients. The indications and the results are discussed on the basis of the various procedures. The results confirm the method of a compressions arthrodesis with an extension screw in case of a posttraumatic arthrosis of the upper ankle joint, while a fixateur externe should be used in case of chronical osteomyelitis, osteoporotic bones, extensive tissue swellings and after a pilon or talus fragment fracture.

Ankle Injuries↗
PubMed1994

Fluid in normal and abnormal ankle joints: amount and distribution as seen on MR images.

OBJECTIVE: The appearance of fluid in tendon sheaths of the ankle joint and in ankle articulations seems to vary. To determine the degree of this variability and to see if fluid occurs in normal ankles, we evaluated the presence, amount, and distribution of joint fluid as seen on MR images of normal and abnormal ankles. MATERIALS AND METHODS: The study included 40 normal ankles of volunteers, 15 ankles of patients with disorders of the posterior tibial tendon, 73 ankles of patients with disorders not involving tendons studied (occult fractures, osteochondritis dissecans, and Achilles tendon disorders), and 46 asymptomatic ankles of patients with disorders of the opposite ankle. We analyzed the MR images of these ankles to determine the volume of fluid in the ankle and subtalar joints. We also analyzed the relative volumes of fluid in tendon sheaths. We then compared the results in patients who had symptoms with those in asymptomatic subjects and developed an algorithm of fluid interrelationships. RESULTS: Most patients had fluid in the ankle (77%) and subtalar joints (72%). Fluid was common around all tendons except the extensor tendons. Large amounts of fluid were particularly common around the flexor hallucis longus tendon (14%). No statistically significant difference in the prevalence or relative volumes of fluid in the subtalar or ankle joints or tendon sheaths was found between normal and abnormal ankles. A close relationship was found between volumes of fluid between tendons, usually those in close proximity to each other. We found no correlation between fluid in the subtalar and ankle joints. CONCLUSION: Our results show that fluid in the articulations and tendon sheaths of the ankle is common in asymptomatic patients, and the amounts of fluid are not significantly different from the amounts in patients with symptoms. There also appear to be complex interrelationships between fluid seen in the joint and in tendon sheaths.

Adolescent↗
PubMed2005

Reconstruction of the form and function of lateral malleolus and ankle joint.

Soft-tissue reconstruction alone cannot obtain normal ankle function in patients with large defects in the area of the lateral malleolus. The authors report a functional reconstructive method for the lateral malleolus, utilized in a male patient whose osteosarcoma in the fibula was resected with surrounding soft tissue. In order to reconstruct the lateral malleolus, the remaining half of the fibula at the knee was removed, and the fibular head was fixed with the tibia at the ankle joint. Ligaments were reconstructed with tendon grafts. Skin and soft-tissue defects were reconstructed with a combined composite flap comprised of a latissimus dorsi myocutaneous flap and a serratus anterior muscle flap. Dead space around the bone graft was filled with the serratus anterior muscle flap that was divided into two portions. The surface was covered with the latissimus dorsi myocutaneous flap. The patient regained almost normal function of the ankle joint. This technique would be a useful functional reconstructive method for patients with large defects in the area of the lateral malleolus.

Adolescent↗
PubMed1997

Does ice immersion influence ankle joint position sense?

The purpose of this study was to determine whether a fifteen minute ice immersion treatment influenced the normal ankle joint position sense at 40% and 80% range of inversion and to establish the length of treatment effect through monitoring the rewarming process. Forty nine healthy volunteers between the ages of 17 and 28 were tested. Subjects were screened to exclude those with a history of ankle injuries. The subject's skin temperature over antero-lateral aspect of the ankle was measured using a thermocouple device during the fifteen minutes ice intervention and thirty minutes post-intervention. Testing of ankle joint position sense using the pedal goniometer was performed before and after a clinical application of ice immersion. The testing required the subject to actively reposition their ankle at 40% and 80% of their total range of inversion. The majority of subjects experienced numbness of the foot and ankle by the fifth or sixth minute during ice immersion. One minute after immersion skin temperatures averaged 15 degrees C + 1.7 degrees C. Skin temperature was seen to rise relatively rapidly for the first ten minutes and then slowed considerably. Subjects had not returned to the pre-test skin temperatures by thirty minutes. A significant difference in ankle joint position sense (p < 0.0499) following fifteen minutes of ice immersion was found. However, the magnitude of this difference (0.5 degree) would not be deemed significant in clinical practice. The research found no significant difference in joint position sense between 40% and 80% of the range of inversion both before and after cryotherapy. These findings suggest that the clinical application of cryotherapy is not deleterious to joint position sense and assuming normal joint integrity patients may resume exercise without increased risk of injury.

Adult↗
PubMed2004

Injury tolerance and response of the ankle joint in dynamic dorsiflexion.

Forced dorsiflexion in frontal vehicle crashes is considered a common cause of injury to the ankle joint. Although a few studies have been published on the dynamic fracture tolerance of the ankle in dorsiflexion, this work reexamines the topic with increased statistical power, adds an evaluation of articular cartilage injury, and utilizes methods to detect the true time of fracture. The objective of this study was to measure the response and injury tolerance of the human ankle in a loading condition similar to that found in a vehicle crash with toepan intrusion. A test fixture was constructed to apply forefoot impacts to twenty cadaveric lower limbs, that were anatomically intact distal to the femur mid-diaphysis. Specimen instrumentation included implanted tibial and fibular load cells, accelerometers, angular rate sensors, and an acoustic sensor. Following the tests, specimens were radiographed and dissected to determine the extent of injury. Eleven of the twenty specimens sustained fracture of the ankle joint. Fractures of the medial malleolus were the most common, while two specimens sustained bimalleolar fractures, and two a talar neck fracture. Other injuries included ligament tears, osteochondral fractures, and cartilage abrasions. Analysis of the acoustic emission indicated that fracture did not always occur at the peak ankle moment. Based on the results of this study, an ankle joint moment of 59 N-m represents a 25% risk of ankle fracture in dorsiflexion for a 50(th) percentile male. When applied to the Thor-Lx dummy, the 25% risk of injury occurs at 36 degrees of dorsiflexion as measured by the ankle potentiometer.

Journal Article↗
PubMed1990

[Biomechanical substantiation of prosthetics of the ankle joint].

In an effort to study the causes of postoperative instability of ankle joint endoprostheses, local mechanical properties of the osseous tissue of tibia and talus were studied in terms of physiological loading on 19 cadaverous preparations in the zones, subjected to resection with the purpose of implant setting. High sensitivity of spongiosa tissue to the local mechanic action and significant reduction of the strength characteristics to the depth from subchondral layer have been noted. It has been ascertained that the main cause of the postoperative instability is the excessively voluminous bone resection, dictated by the structural limitations of the used endoprostheses. Admissible tibia and talus resection zones in case of ankle joint prosthetics have been determined.

Aged↗
PubMed1982

Synovectomy of the ankle joint.

Between 1970 and 1979, 123 synovectomies of the ankle joint were performed on 99 patients. Sixty two of these patients (81 ankles) were followed up for an average period of four years. Using Steinbrocker's classification 10 ankles had Stage I disease, 34 had Stage II, 33 had Stage III and 4 had Stage IV. In more than 80% of the joints pain and swelling significantly decreased after operation, with improvement in the range of motion and of the gait pattern. However the procedure did not change the walking distance or dependency upon walking aids, probably because the ankle joint was rarely the only joint of the lower extremity affected by rheumatoid arthritis.

Adult↗
PubMed1995

Projections of ankle joint afferents to the spinal cord and brainstem of the chicken (Gallus g. domesticus).

The projections of the ankle joint capsule afferents were studied by transganglionic transport of horseradish peroxidase injected directly into the ankle joint. The number and size of the labelled dorsal root ganglion cells were measured from synsacral nerves 2-9. In the dorsal root ganglia, all sizes of sensory neurones were labelled, and the largest number of labelled cells was in ganglia 5-7. The extensive sympathetic innervation of the ankle joint was identified by the large number of cell bodies labelled in the sympathetic ganglia of the paravertebral chain. Labelled afferent fibres projected to the spinal cord from the 2nd to the 8th synsacral nerves, with the rostral projection mainly via Lissauer's tract and the dorsal funiculus. Terminal labelling in the dorsal horn was identified in laminae I-III and VI, with a slight projection to V. Two areas of dense labelling, which did not correspond with the largest number of labelled dorsal root ganglion cells, were identified. A rostral area with the highest density of label was observed at the level of synsacral nerves 3-4 and a second slightly less dense area between synsacral nerves 7-8. In the caudal medulla, diffuse terminal labelling was observed in the nucleus gracilis et cuneatus, nucleus of the tractus solitarius, and the nucleus cuneatus externus. These results are discussed in a comparative context to identify similarities and differences between different primary afferent projections in birds and mammals and to highlight the possible functional significance of the avian articular afferent projection.

Afferent Pathways↗
PubMed1981

[Biomechanics, technique and results of fibular ligamentous grafting at the ankle joint (author's transl)].

The grafting operations according to Watson-Jones and Evans in old fibular capsular ligament lesions of the ankle joint have the effect of tenodesis as far as the talo-calcaneo-navicular joint ist concerned, since especially the natural course of the ligamentum calcaneofibulare, which requires substitution, is not considered. The authors conducted a search for the most favourable course when replacing the ligamenta talofibulare anterius and calcaneofibulare, using a thread model on ankle joint preparations. It is only the direct replacement of these ligaments which is most likely to ensure free mobility of ankle joint and the talo-calcaneonavicular joint with optimal joint stabilization. Courses proceeding differently will lead either to tenodesis or to slackening of the ligamentous replacement without producing a stabilizing effect. From the author's own patient, two groups with anatomically compatible ligamentous replacement with lyodura (n = 12) or with a modified graft of the short peroneal muscle (n = 8) were compared with each other. In accordance with the experimental results, the main difference between the two processes was the restriction in supination of the talo-calcaneo-navicular joint. The authors conclude from their results that duraplasty, which follows the anatomical course of the ligaments to be replaced, is indicated particularly in such patients who require free supination of the foot because they are active in certain types of sport where this is essential.

Ankle Injuries↗
PubMedDate not supplied

[Experiences with an ankle joint motion device in prevention of thrombosis in patients after total endoprosthesis knee replacement].

PURPOSE: Thromboprophylaxis with heparins after total joint replacement is well accepted. The aim of this prospective randomized study was to evaluate the thrombo-prophylactical efficiency of an ankle joint moving device (Artroflow) after total knee arthroplasty. METHOD: In this prospective study 160 patients were examined who had undergone total knee arthroplasty (TKA). All of the 160 patients received Enoxaparin 1 x 40 mg subcutaneously per day. In addition to this, 90 patients received Artroflow three times a day for 30 minutes. The passive movements of the ankle joint lead to an emptying of the foot and calf veins. Except for the daily routine, we performed physical examination and ultrasound in colour, compression and duplex technique one day before surgery and at the 7th and 14th day after surgery. If a thrombosis was suspected, an ascending phlebography was carried through. RESULTS: The overall thrombosis rate was 6.3% (n = 10). 11.4% (n = 70) deep vein thromboses (DVT) could be observed in the group without Artroflow. Thrombosis occurred in the group with Artroflow in 2 cases (2.2%, n = 90). A statistical difference was found between the two patient groups (p < 0.05, Chi-Square-test). One patient was excluded from the study because of pain in the ankle joint at the fourth day of treatment. CONCLUSION: In addition to heparins, this ankle joint moving device can be recommended as a physical way to prevent DVTs in the thromboprophylaxis of total knee arthroplasty.

Adult↗