[Supination dislocation of the ankle].
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Comparing 20 healthy subjects to 31 injured patients in this study it is demonstrated that ultrasound examination appears to be a reliable tool in the diagnosis of ligamentous inversion force injuries of the ankle. The ultrasound diagnosis was confirmed by conventional standard and on the tension X-Rays. When lateral collateral ligaments were ruptured mean differences of 2.3 mm for the anterior talofibular ligament and 5.5 mm for the calcaneofibular ligament, respectively were obtained between X-Rays in standard and on the tension position. In comparison, the values in the control group (no ankle injury) were 1.4 mm and 2.2 mm respectively. The results shown in this study are mainly in keeping with the present literature.
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In 523 consecutive patients with inversion injuries of ankle and foot, X-ray examination revealed 52 fractures. The majority of these fractures could be treated symptomatically. On the basis of clinical examination as the diagnostic tool for these ankle injuries, the need for radiological assessment was decided. All important fractures were recognized. The patient's ability to bear weight on the injured ankle, the presence of lateral malleolar tenderness and advanced age were important clinical variables. Careful physical examination can lead to a selective radiological assessment of acute ankle injuries. Superfluous X-ray procedures can be eliminated which will greatly reduce costs without detriment to patient care.
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Fifty-six primigravid women at 28-32 weeks' gestation were studied prospectively to compare the roll-over test with the stand-up pressor test in the prediction of gestational hypertension. Blood pressures were measured in the different positions continuously using an automated machine. Twenty patients developed gestational hypertension; two of these were accurately predicted by roll-over test and six by stand-up pressor test (P less than .001). However, there was no significant difference between the tests in the rates of false negatives, specificity, and negative and positive predictive values. Concomitant measurement of blood pressures in the standing position may increase the sensitivity of the roll-over test for the prediction of gestational hypertension.
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The posterior interosseous syndrome appears in two forms, a) paralytical, and b) painful. In this investigation the authors report on twelve operated patients with painful posterior interosseous or "radial tunnel" syndrome. The intraoperative findings in the arcade of Frohse are compared with the findings on preparation of ten recently deceased. It was especially significant that in ten of twelve cases there was found intraoperatively a tendinous type of arcade. In the cadaveric studies the authors encountered this type of tendinous arcade in only two of ten specimens. Based on these findings, the authors conclude that the tendinous arcade of Frohse is an important factor in the development of the posterior interosseous syndrome.
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The effectiveness of using 2-inch and 4-inch convoluted foam overlays to protect children from developing pressure sores was investigated in 13 healthy children ranging in age from ten weeks to 13.5 years. Interface pressures were measured under the occipital, sacral, and scapular areas of children as they lay on a standard mattress, then on 2-inch and 4-inch foam overlays. The differences in pressures between the occiput and scapula, occiput and sacrum, and scapula and sacrum were significant (p less than .001), with the highest pressures recorded under the occipital area. Occipital pressures decreased from 45.7mmHg on the standard mattress to 22.3mmHg on the 4-inch overlay in ages 0 to 2, 54.3mmHg to 30.5mmHg in ages 2 to 10, and 78.0mmHg to 42.4mmHg in ages 10 to 14. Sacral pressures were highest in older and larger children, increasing from 17mm Hg in ages 0 to 2 to 34mmHg in ages 10 to 14, and when body surface area was greater than 1m2. These results indicate that the site of greatest pressure changes with increasing age from the occipital area to the sacral area. Therefore, different pressure relief considerations are necessary in treating pediatric patients than in managing pressure under adults.
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