The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Injuries to the ankle tend to be some of the most common injuries seen in practice. Of these ankle injuries, fractures of the posteromedial process of the talus are often misdiagnosed as ankle sprains because of poor visualization on routine ankle radiographs. ⋯ Proper treatment could help to lessen the possibility of post-traumatic arthritis to the ankle and subtalar joints. The authors present a case of a fracture of the posteromedial process of the talus, after a medial subtalar dislocation, treated with open reduction and internal fixation with bioabsorbable pins.
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Diastasis of the distal tibiofibular syndesmosis is commonly seen with ankle fractures, but is a rare finding in the absence of fracture. The anatomy, biomechanics, mechanism of injury, evaluation, and radiographic assessment of the tibiofibular syndesmosis are reviewed. The authors present a review and two cases of traumatic ankle diastasis without ankle fracture.
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Review
Functional instability of the ankle and the role of neuromuscular control: a comprehensive review.
A review of current knowledge of the clinical syndrome of functional ankle instability is presented. Recent evidence has demonstrated that the majority of patients with functional instability of the ankle do not have mechanical hypermobility of the ankle joint. Functional instability of the ankle results from a loss of neuromuscular control. ⋯ Proprioception and eversion muscle strength improve with the use of passive supportive devices. Balance and postural control of the ankle appear to be diminished after a lateral ankle sprain and can be restored through training that is mediated through central nervous mechanisms. Methods of detecting deficits in neuromuscular control are presented along with rehabilitation techniques to treat functional instability of the ankle.
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Case Reports
Complex regional pain syndrome: a report of two cases recalcitrant to usual treatment protocols.
In this report the authors present a review of complex regional pain syndrome and two case reports of complex regional pain syndrome that were recalcitrant to the usual treatments. The first case presented is a middle-aged female who developed signs and symptoms of post-traumatic complex regional pain syndrome. The second case is a woman with a pre-existing history of complex regional pain syndrome whose condition worsened after surgery despite appropriate perioperative precautions. These cases are unique because in both cases an early diagnosis of complex regional pain syndrome was established, yet they were both resistant to the usual treatment protocols.
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Review Case Reports
"Floating tibia-talus complex"--an ipsilateral dislocation of the knee and the subtalar joint in an elderly patient: a case report and review of the literature.
Knee dislocation is defined as a radiographically confirmed total loss of the tibiofemoral articulation. This rare injury is believed to be the result of a high-impact trauma. Knee dislocations are classified according the direction of tibial displacement with respect to the femur. ⋯ These injuries are also quite rare and are mostly (80%-85%) classified as medial subtalar dislocations with the calcaneus lying medially, the head of the talus being prominent dorsolaterally and the navicular located medial and dorsal to the talar head. The authors report the case of an elderly patient who suffered ipsilateral anterior dislocation of his left knee and medial subtalar dislocation of his left foot. The authors believe this to be the first presentation in the English literature of an ipsilateral combination of these two injuries on the same limb.