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Ankle fractures
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Oliver Chan, Anthony Sakellariou
Fractures involving the posterior malleolus have been classified by two systems based on CT scan findings. Haraguchi et al (8) described three types of posterior malleolus fracture based on the axial reconstructions of the CT scan (Figure 15.5). With a Type 1, there is a single posterolateral fragment. A Type 2 includes extension of the fracture to the posteromedial side of the distal tibia and Type 3 fractures represent a thin shell of bone. This system is useful as Type 3 fractures may be too small to fix and the presence of a Type 2 fracture may dictate a posteromedial approach.
Fundamentals
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
To determine on which side of a segment a point lays, medial is used to indicate a point that is closer to the midline of the body, and lateral indicates that a point is further away from the midline. For example, the medial malleolus is the bone on the inside of the ankle, closer to the midline, and the lateral malleolus is the bone on the outside of the ankle, further away from the midline (see ankle and foot – bones). Finally, to indicate how close to the centre of a segment a point lies, the terms superficial and deep are used, such that skin is superficial to muscle.
Diagnostic research
Published in Nicholas Summerton, Primary Care Diagnostics, 2018
In assessing the applicability of clinical indicants one sequence is illustrated by the development of the ‘Ottawa ankle rules’ for acute ankle injuries. In 1992 Stiell et al. undertook a study of 750 emergency department patients over a 5-month period. They surveyed for 32 standardised clinical variables that were compared against a radiographic gold standard in order to develop clinical indicants for malleolar fractures. Such fractures were more likely to be identified among people who had pain near the malleoli and who were aged 55 years or more, had localised bone tenderness of the posterior edge or tip of either malleolus, or were unable to bear weight both immediately after the injury and in the emergency department.23
Effects of range of motion exercise of the metatarsophalangeal joint from 2-weeks after joint-preserving rheumatoid forefoot surgery
Published in Modern Rheumatology, 2020
Makoto Hirao, Hideki Tsuboi, Naotaka Tazaki, Kohei Kushimoto, Kosuke Ebina, Hideki Yoshikawa, Jun Hashimoto
The subjects walked on a 10-m walkway with 5 1.4-cm-diameter reflective markers placed at specific landmarks of the foot (1. medial malleolus, 2. lateral malleolus, 3. 3 cm proximal of the insertion of the Achilles tendon, 4. second metatarsal head, and 5. second distal phalanx) (Figure 2(a1–3)). Gait motion was recorded in three dimensions using a 12-Raptor camera infrared motion analysis system (MAC 3D system, Motion Analysis, Corp., Rohnert Park, CA, USA) at a sampling frequency of 500 Hz. The captured data were analyzed using a toolkit: Software for Interactive Musculoskeletal Modeling (SIMM, Motion Analysis, Corp.). In the analysis of gait motion, the extension angle of the second MTP joint at the terminal stance phase (when the heel was most elevated) was measured (Figure 2(a-3,b-1.2)). The difference between the terminal stance phase and the standing still phase in the angle created by the longitudinal axis of the second metatarsal bone and the basal phalanx bone was defined as the extension angle of the second MTP joint at the terminal stance phase (Figure 2(b-2)). As healthy controls, the analysis was also performed in healthy subjects (N = 5, age: 26–35 years, no rheumatoid arthritis, no disorder of the lower extremities including the feet and ankles) (Table 2).
An unexpected complication of nonoperative treatment for tibial posterior malleolus fracture: bony entrapment of tibialis posterior tendon – a case report
Published in Acta Orthopaedica, 2019
Thomas Amouyel, Baptiste Benazech, Marc Saab, Nadine Sturbois-Nachef, Carlos Maynou, Patrice Mertl
While displaced medial and lateral malleolus fractures are often operated on, allowing the diagnosis of the tendon entrapment, posterior malleolus fractures are often neglected or fixed with anterior to posterior screws through a percutaneous approach (Solan and Sakellariou 2017). Internal fixation seems recommended for posterior malleolus fractures involving more than 25% of the articular surface to achieve anatomical reduction (Gardner et al. 2011, Mingo-Robinet et al. 2011). Surgery via a postero-lateral or postero-medial approach allows for anatomical reduction and direct control of tendon and soft tissue entrapment, and thus reduces the risk of malunion. Recent research articles showed good results in patients with posterior malleolus synthesis by screw or buttress plate, without increasing the complication rate due to the postero-lateral approach (Verhage et al. 2016, Bali et al. 2017, Gougoulias and Sakellariou 2017).