1/228. Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete. Rationale, indications, techniques, and results.New techniques for articular cartilage transplantation have become available recently for traumatic chondral injuries. Applications to the athlete have generated considerable interest in the sports medicine community. The autogenous osteochondral grafting mosaicplasty has been used to treat these injuries in the athlete population for the past six years. The rationale, indications, operative technique, results, and limitations of mosaicplasty in the athlete are presented and discussed.- - - - - - - - - - ranking = 1keywords = trauma (Clic here for more details about this article) |
2/228. Recognition and management of Tillaux fractures in adolescents.Tillaux fractures are relatively uncommon Salter Harris III fractures of the tibia. The importance of recognizing this fracture is that a residual deformity in the joint surface can lead to premature degenerative arthritis. For this reason, it is important that accurate imaging to assess the congruity of the joint, as well as adequate reduction, is obtained. These fractures can occur in adolescents in the 18-month period during which the distal tibial epiphysis is closing. These injuries occur either by lateral rotation of the foot or by medial rotation of the leg on the fixed foot. Closed reduction is sufficient in most cases; however, if a gap of > or = 2 mm of the articular surface remains, open reduction is usually required to adequately reduce the articular surface. Orthopedic injuries are one of the most common reasons children are brought to the emergency department (ED). Most of these injuries are easily managed by splinting, with outpatient orthopedic follow-up. However, certain fractures need closer evaluation and immediate consultation with an orthopedic surgeon. One relatively uncommon fracture that needs special attention is the Tillaux fracture. Paul Jules Tillaux first described this particular fracture in 1892. He performed experiments on cadavers and found that stress to the anterior inferior tibiofibular ligament could lead to this type of avulsion fracture, which today is termed the Tillaux fracture. The distal tibial epiphysis is involved, and the mechanism usually is forced external rotation of the foot in a 12- to 14-year-old adolescent. This fracture only occurs during a certain time of adolescence, owing to the differential growth rate of the epiphysis, and only under certain circumstances. The fracture is of great importance because it involves a major weight-bearing articular surface. A residual deformity of the joint surface can lead to premature degenerative arthritis. We present a patient with a Tillaux fracture to elaborate on the mechanism of injury and to summarize the importance of its recognition and imaging and treatment options.- - - - - - - - - - ranking = 845.06571593658keywords = injury (Clic here for more details about this article) |
3/228. Radiologic case study. Fractures of the foot masquerading as ankle injuries.An ankle radiographic series frequently is obtained when a patient presents with an acute ankle and foot injury. Although many fractures are confined to the ankle and are readily apparent, fractures of the foot can mimic ankle injuries. It is important to differentiate these fractures of the foot from the more common ankle sprain. Most ankle sprains are treated with ice, compression, and elevation, followed by range-of-motion exercises and progressive weight bearing as tolerated. When foot fractures are not identified, however, lack of appropriate treatment can result in late complications. Concentration on key areas as described here will reduce the incidence of missed fractures of the foot in these patients.- - - - - - - - - - ranking = 845.06571593658keywords = injury (Clic here for more details about this article) |
4/228. weight-bearing immobilization and early exercise treatment following a grade II lateral ankle sprain.STUDY DESIGN: Case study. OBJECTIVES: To describe a protocol used in the rehabilitation of a grade II lateral ankle sprain, emphasizing brief immobilization with a removable boot, weight bearing as tolerated, and progression of early exercise. BACKGROUND: The optimum conservative treatment of severe grade II ankle sprains remains undefined. Short-term benefits of early mobilization have won favor over immobilization by casting; however, pain and ankle joint instability often linger. The timing of weight bearing as a variable that influences recovery has largely been ignored when either treatment is considered. methods AND MEASURES: The patient was a 17-year-old girl who had sustained a left ankle inversion sprain while playing high school basketball. The sprained ankle was placed in an immobilizer boot for 1 week, and weight bearing was encouraged. She received instructions for active exercise and for resistive exercise with elastic tubing. Volumetric and active range of motion measurements and gait observation provided indicators of rehabilitation progress. A digital inclinometer was used to measure active range of motion in the sagittal plane. Vertical ground reaction forces recorded with an instrumented treadmill documented gait symmetry. RESULTS: The patient responded well to the course of treatment, returning to full participation in basketball 2 weeks after the injury. The injured ankle had 29% (19 degrees) less active range of motion than the nonimpaired ankle at the beginning of physical therapy. The injured ankle also displaced 50 mL more water compared with the nonimpaired ankle at the start of treatment. Four weeks after beginning treatment, the sprained ankle had 4 degrees less active range of motion and displaced 5 mL more water compared with the nonimpaired ankle. As a college athlete, the patient has remained free of subjective complaints of ankle pain, instability, and swelling. CONCLUSION: weight-bearing immobilization combined with early exercise provided safe and effective treatment for this patient, who suffered a grade II lateral ankle sprain.- - - - - - - - - - ranking = 845.06571593658keywords = injury (Clic here for more details about this article) |
5/228. Osteoid osteoma of the lateral talar process presenting as a chronic sprained ankle.Pathologic conditions of the lateral talar process may be difficult to diagnose using physical examination and roentgenographs. A computed tomography scan of the hindfoot is often useful to define lesions of the lateral process. We report a case of osteoid osteoma of the lateral talar process that defied diagnosis for 4 years. The patient had an antecedent history of an inversion injury, which had been treated as a chronically painful sprained ankle without resolution of symptoms. The tumor was ultimately identified on a computed tomography scan, best seen on a coronal section through the talus. The patient had complete relief of pain after excisional biopsy of the tumor.- - - - - - - - - - ranking = 845.06571593658keywords = injury (Clic here for more details about this article) |
6/228. Anterior tibial aneurysm following inversion injury to the ankle.Arterial injuries in nonpenetrating low-energy injuries to the extremities are rare but can occur when joint injuries put the vessels in traction against their immobile attachments to the long bones. The most common injuries are to the popliteal artery (because of its tethered nature proximal to the popliteal fossa) and the brachial artery (because it is tethered to the humerus proximal to the elbow). The second reported case of an aneurysm of the anterior tibial artery resulting from an inversion injury to the ankle is described.- - - - - - - - - - ranking = 4225.3285796829keywords = injury (Clic here for more details about this article) |
7/228. Complex regional pain syndrome.Complex regional pain syndrome is a chronic pain syndrome that is often instigated by postoperative or post-traumatic events. The disease process can progress through three stages, the first of which tends to respond best to treatment. A review of the literature is presented, followed by a report of a patient who developed symptoms of complex regional pain syndrome following a water-skiing accident.- - - - - - - - - - ranking = 1keywords = trauma (Clic here for more details about this article) |
8/228. hydrofluoric acid burns of the lower extremity.Chemical burns to the lower extremity can be disabling and of serious consequence if not managed properly. The severity and rapid onset of the burns caused by hydrofluoric acid after initial contact make this a highly dangerous substance. The potential severity of injury and the following complications make it a chemical of which all physicians should have a basic understanding.- - - - - - - - - - ranking = 845.06571593658keywords = injury (Clic here for more details about this article) |
9/228. Pseudoaneurysm of the lateral malleolar artery after an ankle sprain: case report and review of the literature.A pseudoaneurysm of the peroneal artery or one of its branches is rare after trauma. The diagnosis is frequently delayed, resulting in substantial morbidity to the patient. The infrequent occurrence of this condition has resulted in a lack of diagnostic and treatment guidelines. However, when recognized, prompt attention involving either surgical ligation or embolization of the injured arterial branch is the most reliable method of treatment. Presented is a report of a patient who developed a lateral malleolar arterial pseudoaneurysm after an ankle sprain, which was treated successfully with aneurysmal excision and surgical ligation of the injured arterial branch. A review of the literature and treatment recommendations follow.- - - - - - - - - - ranking = 1keywords = trauma (Clic here for more details about this article) |
10/228. Traumatic aneurysm of the perforating peroneal artery following ankle fracture.This report describes a case of traumatic aneurysm of the perforating peroneal artery following open reduction and internal fixation of an ankle fracture.- - - - - - - - - - ranking = 1keywords = trauma (Clic here for more details about this article) |
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