[Role of primary arthrodesis of severe crush injuries of the knee and ankle joints].
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We herein describe a Japanese family suffering from autosomal dominant limb-girdle muscular dystrophy showing a later onset and a predilection for males. All patients developed a plantar flexion contracture of the ankles when no distal muscular weakness was evident. The serum creatine kinase activity was remarkably elevated to 55 times the normal value. These clinical features suggest a novel phenotype.
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Subject of this investigation is the influence of postoperative tibio-fibular ossification on the development of arthrosis of the ankle. Changes of the biomechanics of the joint can be evaluated by computed tomography. Posttraumatic and postoperative changes of the mobility of the fibular in relation to the tibia may be quantified by CT investigation and evaluated with respect to the development of arthrosis.
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Ligament rupture occurs at the maximum breaking load. During ligament healing, contraction and remodeling of the scar is sufficiently advanced at 6 weeks to reach 60 to 70% of the initial strength. There is evidence of an early improvement in biomechanical properties of repaired ligaments. This advantage, however, may not be sustained as, after one year, sutured and unsutured ligaments have nearly equal length when measured at rest and comparable failure strength when subjected to exercise. Each of the ankle ligaments has a role in stabilizing the ankle and/or subtalar joint. Beside of maintaining lateral ankle stability, the lateral ankle ligaments have been shown to play a significant role in providing rotational ankle stability. This is especially true for the anterior talofibular ligament. A loss of this ligament does allow for an increase in foot inversion and external rotation of the leg to occur, without any tilting of the talus or subtalar gapping. It is this increase in foot inversion which may lead to a symptomatic instability. When treating ankle instability, it is therefore important for the clinician to take the alteration of hindfoot biomechanics into consideration. This is especially the case for any surgical repair of injured ankle ligaments. Unphysiological tenodesis procedures should be avoided.
The authors have reviewed 26 cases of tuberculosis of the foot and 32 of the ankle, which they have treated personally. All the patients were adults and most presented with advanced destruction of bone and joints. Bacterial and histological confirmation of the diagnosis was obtained in 56 patients. All were treated by chemotherapy; the drugs and regime varied over the years. All responded well to this treatment, but one relapsed after 24 months. Orthopaedic problems were usually managed by immobilisation in plaster casts, but 6 patients required arthrodesis, 5 of the ankle and one triple fusion. The functional results of the standard treatment were generally good. Arthrodesis is seldom needed and should be performed only for permanent pain or crippling deformity.
Today, more emphasis is being placed on ambulatory surgery and its decreased morbidity. Arthroscopic surgery is a valid approach to many disease entities and is very responsive to early ambulation. The authors present a brief history of ankle arthroscopy--the technique, indications and contraindications, difficulties, and possible complications of the procedure.
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