Some properties of spastic ankle joint muscles in hemiplegia.
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In cases of lateral ankle injury, although acute ligament ruptures are best treated non-operatively with physiotherapy (range-of-motion and co-ordination training, and peroneal muscle strengthening exercises), about 10-20 per cent of patients nonetheless develop chronic functional instability: While this is not severely disabling, ligament reconstruction may be necessary in specific cases, e g for those with high demands of ankle stability. Of the more than 50 surgical approaches published, several have become classic reconstructive procedures widely used--e g, those of Evans and Watson-Jones (with disappointing long-term results), and that of Chrisman-Snook (with satisfactory long-term outcome). However, anatomical ligament reconstruction (with shortening, re-insertion and imbrication of the healed but elongated ligament) is a simple procedure with good short- and long-term results, which may often be a better alternative than other more complex reconstructive procedures.
A questionnaire was mailed to 400 orthopaedic department chairpersons in Germany listed by the "Deutsche Gesellschaft für Unfallchirurgie" to evaluate the current surgical approach to chronic ankle instability. The aim of the survey was to analyze and to classify the reconstruction method of the individual institution. Questionnaires were returned from 267 hospitals (66.7%). The number of ligament reconstructions performed at individual institutions ranged from 1 to over 100 (mean 17.5). The most frequently used procedures of primary choice for reconstruction of the ligaments are: periosteal flaps (45.3%), anatomical repair (23.6%), different tenodeses (20.6%), and free anatomical implants of autologous or exogenous material (10.5%). 50% of the participants use reconstructions in which the injured ligament is repaired secondarily without augmentation or with periosteal flaps. The remaining part of the German surgeons prefers tenodeses or various other procedures. It is interesting to note that there is a high number of different procedures not namely known in the literature which are considered as individual modifications. With better knowledge of the function of the single ligament and general exposure of the ligaments for simple overlap and direct suture, the rate of primary non-anatomical reconstructions may be decreased in the future.
A total of 64 patients with open fractures of the ankle were reviewed to assess the benefits of rigid primary internal fixation. Of these, 27 patients were treated by rigid primary internal fixation; the remainder were treated by a combination of internal splintage with K-wires and plaster casting. Patients who were treated by rigid primary fixation fared better in terms of joint mobility, maintenance of reduction and reduced sepsis rate. An interesting observation, in some of the displaced fractures, was the presence of débris far removed from the site of the wound. This was obviously sucked in during the mechanism of the injury. This has not been described previously. A method of decontaminating such wounds is discussed.