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[Semi-malignant giant cell synovioma as an incidental finding in open dislocated fracture of the upper ankle joint].

A rare statement is demonstrated with reference to a case concerning a sixteen years old girl who caught an open luxation fracture of her upper ankle joint by a sudden fall from a horse on August 8, 1988. During the operative treatment a spontaneously loosing soft tissue tumor of plumlike size could be obtained. The histological analysis proved a semimalignant giant cell-synovialom.

Adolescent↗

Normal and abnormal arthroscopic anatomy of the ankle joint.

Normal and abnormal intraarticular anatomy of the ankle is presented from an arthroscopist's perspective. Pathologic anatomy including synovitis, transchondral fracture, impingement lesions, osteochondral bodies, and erosions are described. A classification of chondromalacia and current concepts of its pathogenesis are presented.

Ankle Injuries↗

[Diagnosis of ligament injuries of the upper ankle joint].

Solitary rupture of ligaments of the upper ankle mostly are caused by injury of supination, more seldom by injury of pronation. The anterior and posterior syndesmosis may be damaged by forced rotation of the foot, if the foot is fixed in 90 degrees or in dorsal extension. Diagnosis of rupture of the fibular ligaments bases on physical examination and is completed by x-ray examination: pressed x-ray pictures in two levels, whereby beside the angle between tibia and talus and beside the anterior displacement of foot the increasing distance between talus and the tip of the fibula is of special importance. It is given account of 390 own cases within one year. Damage of the deltoid ligament and the anterior and posterior syndesmosis is diagnosed by physical examination and pressed x-ray pictures respectively arthrography. The diagnosis of these injuries is the precondition for sufficient treatment.

Adolescent↗

[Bone repair in pseudarthrosis after arthrodesis of the upper ankle joint].

Delayed union or non-union of ankle arthrodesis is a common problem and revision arthrodesis is necessary in those difficult cases. Three cases are presented, in which a non-union after tibiotalar or tibiacalcanear fusion could be treated effectively with a bone graft taken from the anterior cortex of the distal tibia or from the anterior iliacal spine. The bone graft was fixed proximally with a screw. Distally the graft was inserted in an slot gouged into the talus or the calcaneus respectively with or without screw fixation. Postoperative care included short-time external fixation and immobilisation with a shortleg weight bearing cast. We conclude that the technique of a sliding tibiotalar graft can be used for effective treatment of non-union following ankle arthrodesis.

Adult↗

Ankle joint arthroscopy for meniscoid lesions in athletes.

The meniscoid lesion is a frequent but not well known cause of persistent pain in the anterior part of the upper ankle in sports traumatology. It has been described as portions of hyalinized tissue following an inversion sprain of the ankle. Trapping of this formation between the lateral cheek of the talus and the fibula is supposed to be responsible for pain and other symptoms reported by the patient. In 59 arthroscopic procedures on the ankle joint in athletes, meniscoid lesions were seen in 19 cases. Only 1 of these 19 patients showed lateral and anterior instability, and frequent clinical symptoms were swelling and trapping. Intraoperatively, all meniscoid lesions were combined with synovitis. Chondromalacia and osteophytes were seen several times. After an average follow-up period of 12 months, 14 patients could be examined. Twelve of the athletes returned to full sports activity; 10 were very satisfied, 2 satisfied, and 2 unsatisfied. Nine patients did not complain of any swelling, 4 did so on rare occasions, and 1 complained persistently. No pain was reported 10 times, improvement of pain 3 times, and continuing persistent pain 1 time, probably because of simultaneous chondromalacia and osteophytes. These were found more frequently in patients with a longer case history and unsuccessful conservative treatment, so that early arthroscopic surgery is recommended.

Adult↗

[Flexion contracture of the upper ankle joint from its phlebologic aspects].

We report on talipes equinus as a consequence of chronical venous insufficiency, stage IV, and the therapeutic approaches. We describe in detail the autogenous mobilization of the proximal ankle joint. Regular measurements of the degree of ankylosis can objectify the findings, control the course of therapy, and motivate the patients.

Clubfoot↗