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[Are fractures of the upper ankle joint to be treated conservatively? (author's transl)].

By means of 796 fractures of the upper ankle-joint, the treatment and results of the therapy according to the conservative-viewpoints are going to be discussed. Comparing the results after operative treatment, conservative therapy today is only justified with fractures of th type A and B under the presumption that there is no subluxation of the talus of the latter mentioned. Bimalleolar fractures of the type A can also be treated conservatively with good results if the inner-ankle fracture has not resulted in the destruction of the ankle-fork. All other fractures should have open reduction and internal fixation. Special attention shall be paid to the reconstruction of the complex fibula-syndesmosis.

Adolescent↗

[Fresh ligament injuries at upper ankle joint and foot (author's transl)].

Crush injuries and abnormal pronation and supination are the most common reasons for typical ligament tears in this region. Most of them should be treated conservatively by plaster of Paris and early weight-bearing after exact clinical and X-ray diagnosis. At upper ankle joint, suture of ruptured fibular collateral ligaments should be favoured. For dislocations and fracture dislocations of the Lisfranc type operative reposition and K-wiring is recommended. Our treatment results with fibular collateral ruptures and fracture dislocations of the Lisfranc type are presented.

Ankle Injuries↗

Influence of heel height on ankle joint moments in running.

Clinically, heel lifting or heel wedging in running shoes has been proposed as a prevention and treatment of Achilles tendinitis. It has been speculated that heel lifting decreases the Achilles tendon forces. The purpose of this study was to determine the effect of heel height on resultant ankle flexion moments during running. It was assumed that plantarflexion moments at the ankle joint would indicate Achilles tendon loading. Each of the five subjects performed five running trials (4.6 m.s-1) for each of the five shoes, differing only in heel height (2.1-3.3 cm). Resultant plantar-/dorsiflexion moments were calculated using a standard three-dimensional inverse dynamics analysis. The results showed that, typically, a small initial dorsiflexion moment took place changing into a larger plantarflexion moment before 20% of stance phase. The magnitude and time of occurrence of the initial dorsiflexion moment were significantly affected by heel height changes, but the maximum plantarflexion moment and its time of occurrence were not significantly affected. The results did not support the speculation that a heel lift generally decreases the Achilles tendon loading during running. However, single subject analyses indicated that for two subjects the plantarflexion moments decreased with increasing heel height.

Achilles Tendon↗

Mobility of the ankle joint: recording of rotatory movements in the talocrural joint in vitro with and without the lateral collateral ligaments of the ankle.

A method for graphic recording of rotatory movements in osteoligamentous ankle preparations is described. By this method it is possible to record characteristic mobility patterns in two planes at the same time. The ankle is affected by a known torque, so that the individual mobility patterns are reproducible with unchanged condition of the ligaments. Six amputated legs were investigated in the sagittal and horizontal planes and another six in the sagittal and frontal planes. Mobility patterns were recorded with intact ligaments and after successive cutting of the lateral collateral ligaments of the ankle in the anteroposterior direction. In the sagittal plane increased dorsiflexion was observed after total cutting of the lateral ligaments, while plantar flexion remained unchanged. In the horizontal plane the internal rotation of the talus increased in step with increasing injury to the ligament, particularly when the ankle was plantar flexed. When all collateral ligaments had been cut, an increase in external rotation occurred, especially in dorsiflexion. In the frontal plane the talar tilt increased gradually with increasing injury to the ligaments. Talar tilt was at a maximum in the neutral position of the ankle or in plantar flexion. After total severing of the collateral ligaments, however, talar tilt was most marked in dorsiflexion of the ankle.

Ankle Joint↗