[Fate of the ankle joint after fracture and results of therapy with regard to 1st aid].
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This paper discusses MR imaging in injuries to the lateral collateral ankle ligaments. Based on recent publications and our own results MR imaging may be useful for demonstration of ankle ligament tears. However, clinical outcome can probably not be predicted by such diagnosis. MR imaging may still be useful in certain settings, such as suspected additional trauma to medial ligaments, bone, or articular cartilage. In chronic pain MR imaging may be indicated for demonstration of articular bodies, occult fractures, significant cartilage damage, tendon injuries and dislocations, and soft tissue scars.
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In the literature more than 30 methods of syndesmoplastic surgery are described for the treatment of chronic ligament instability in the ankle. The aim of our investigation was, on the basis of long-term results, to determine which surgical method has the least complications, which offers the best chances from the viewpoint of exercise and sports, and whether degenerative changes in the joint can be avoided by restitution of stability. By means of isokinetic testing with 36 patients we were able to determine differences in the long-term results of various surgical methods, viz. syndesmoplasty using the peroneus brevis muscle as modified by Evans and Watson/Jones, respectively, and periosteal syndesmoplasty. In the period from 1980 through 1990, at the Graz Hospital for Trauma Surgery we performed 77 syndesmoplastic operations on 75 patients suffering from chronic ligament instability in the ankle joint. Of these cases, 45 were followed up for 6-136 months after the operation. On the basis of the results of these postoperative examinations we recommend periosteal syndesmoplasty for management of chronic ligament instability in the ankle, as this method is relatively easy to perform, prevents post-traumatic arthrosis, ensures maximum stability, which consequently means a low complication rate, and shows favorable final results in isokinetic testing.
In 26 patients we performed an arthroscopically assisted arthrodesis of the ankle. The patients' ages ranged from 31 to 69 years. The male:female ratio. Sixteen patients had posttraumatic degenerative joint disease, three patients suffered from a previous infection, four patients had rheumatoid arthritis, and three patients had an osteochondritis dissecans in their past history. The time taken for surgery ranged from 65 to 135 min. Compared with open procedures we documented less postoperative swelling and minor use of analgesics. Time of follow-up was a minimum of 6 months and a maximum of 75 months. In 22 patients we found solid fusion at the time of followup. Fusion was accomplished by 2 months postoperatively in four patients, by 3 months in nine patients, by 4 months in another six patients, and by 6 months in 3 patients. Three patients did not evidence any bony fusion, but they were free of pain. In one patient an open revision was necessary. According to our experience, we recommend arthroscopically assisted arthrodesis of the ankle in patients with degenerative joint disease without rotational or varus/valgus malalignment, severe bone defects or neuropathic disease.
UNLABELLED: We documented the effect on sports specific capabilities of long lasting wear of ankle braces in 14 handball players. For a period of 4 months half of the team performed all athletic activities with an ankle brace. The other players served as control performing the same athletic activities without wearing a brace. For documentation of the coordinative capabilities a special jump-test with a COMET-system was used. This test was performed after a standardised warm-up at the beginning and at the end of the 4 months observation period with and without an ankle brace. The results showed that wearing the used ankle brace for a period of 4 months did not lead to a negative effect on jumping capabilities. The brace group showed even an increased ability in the used test. This could be documented in short as well as long term effects. CONCLUSION: Long wear of ankle braces do not lead to negative side-effects in sports specific capabilities that are represented by the performed jump-test.
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