Diagnosing syndesmotic instability in ankle fractures.

The precise diagnosis of distal tibiofibular syndesmotic ligament injury is challenging and a distinction should be made between syndesmotic ligament disruption and real syndesmotic instability. This article summarizes the available evidence in the light of the author's opinion. Pre-operative radiographic assessment, standard radiographs, computed tomography scanning and magnetic resonance imaging are of limited value in detecting syndesmotic instability in acute ankle fractures but can be helpful in planning.

Computed tomography of the ankle in full plantar flexion: a reliable method for preoperative planning of arthroscopic access to osteochondral defects of the talus.

Purpose: The purpose of this study was to determine whether preoperative computed tomography (CT) of the ankle joint in full plantar flexion is a reliable and accurate tool to determine the anterior arthroscopic accessibility of talar osteochondral defects (OCDs).

Methods: Twenty consecutive patients were prospectively studied. All patients had an OCD of the talar dome and had a preoperative CT scan of the affected ankle in maximum plantar flexion.

Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement.

Background: The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability.

Questions/purposes: We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans.

Methods: Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced scaphoid fractures for the presence of displacement, using a web-based rating application.

Osseous and ligamentous scaphoid anatomy: Part II. Evaluation of ligament morphology using three-dimensional anatomical imaging.

Purpose: There are many controversies in the literature regarding the morphology of the scaphoid ligaments. The aim of this study was to provide a more accurate description by quantitatively describing the 3-dimensional, geometrical aspects of the scaphoid ligaments and their attachments, using cryomicrotome images of cadaveric wrists.

Methods: Eight fresh-frozen human cadaver wrists were examined with computed tomography (CT) and an imaging cryomicrotome.

Osseous and ligamentous scaphoid anatomy: Part I. A systematic literature review highlighting controversies.

Purpose: The interpretation of scaphoid anatomy and kinematics is confusing and controversial. This results from a lack of consensus on the anatomy of the ligaments attaching to the scaphoid and an overwhelming variety of substantially different anatomic descriptions and classification systems of the wrist joint in the literature. The present study systemically reviews the consistencies or inconsistencies of the various scaphoid ligament descriptions and aims to clarify and unify different concepts and classification systems.

[A woman with a swelling of her left upper leg].

A 27-year-old woman came to the clinic with a tumour of her left upper leg: grade I chondrosarcoma, transformed from an osteochondroma. Radical excision with a total hip arthroplasty using a tumour prosthesis was performed.

The influence of foot geometry on the calcaneal osteotomy angle based on two-dimensional static force analyses.

Background: Malalignment of the hindfoot can be corrected with a calcaneal osteotomy (CO). A well-selected osteotomy angle in the sagittal plane will reduce the shear force in the osteotomy plane while walking. The purpose was to determine the presence of a relationship between the foot geometry and loading of the calcaneus, which influences the choice of the preferred CO angle.

Two-dimensional and three-dimensional computed tomography for the classification and characterisation of tibial plateau fractures.

Background: Complex tibial plateau fractures can be difficult to characterise on plain radiographs and two-dimensional computed tomography (2D CT). The present study evaluated whether three-dimensional computed tomography (3D CT) reconstructions can improve the reliability of complex tibial plateau fracture characterisation and classification.

Methods: Forty-five consecutive intra-articular fractures of the tibial plateau were evaluated by six independent observers for classification according to standard systems and for the presence of six characteristics: (1) posteromedial shear fracture; (2) coronal plane fracture; (3) lateral condylar impaction; (4) medial condylar impaction; (5) tibial spine involvement; and (6) separation of tibial tubercle necessitating fixation.

Performance of arthroscopic irrigation systems assessed with automatic blood detection.

Purpose: During arthroscopies, bleeding episodes occur as a result of tissue damage. Irrigation systems assist in minimizing these disturbances. The performance of three arthroscopic irrigation systems in clearing bleeding episodes was evaluated objectively.

Ankle fusion using a 2-incision, 3-screw technique.

Objective: Reliable fusion and optimal correction of the alignment of the ankle joint using a 2-incision, 3-screw technique.

Indications: Symptomatic osteoarthritis of the ankle joint after insufficient other treatment, severe deformity of the osteoarthritic ankle joint, or salvation procedure after failed arthroplasty.

Contraindications: Active osteomyelitis, very poor soft tissues, or severe peripheral arterial occlusive disease.

Does perception of usefulness of arthroscopic simulators differ with levels of experience?

Background: Some commercial simulators are available for training basic arthroscopic skills. However, it is unclear if these simulators allow training for their intended purposes and whether the perception of usefulness relates to level of experience.

Questions/purposes: We addressed the following questions: (1) Do commercial simulators have construct (times to perform tasks) and face validity (realism), and (2) is the perception of usefulness (educational value and user-friendliness) related to level of experience?

Methods: We evaluated two commercially available virtual reality simulators (Simulators A and B) and recruited 11 and nine novices (no arthroscopies), four and four intermediates (one to 59 arthroscopies), and seven and nine experts (> 60 arthroscopies) to test the devices.

Direction of the oblique medial malleolar osteotomy for exposure of the talus.

Introduction: A medial malleolar osteotomy is often indicated for operative exposure of posteromedial osteochondral defects and fractures of the talus. To obtain a congruent joint surface after refixation, the oblique osteotomy should be directed perpendicularly to the articular surface of the tibia at the intersection between the tibial plafond and medial malleolus. The purpose of this study was to determine this perpendicular direction in relation to the longitudinal tibial axis for use during surgery.

Soft tissue damage after minimally invasive THA.

Background And Purpose: Minimally invasive surgery (MIS) for hip replacement is thought to minimize soft tissue damage. We determined the damage caused by 4 different MIS approaches as compared to a conventional lateral transgluteal approach.

Methods: 5 surgeons each performed a total hip arthroplasty on 5 fresh frozen cadaver hips, using either a MIS anterior, MIS anterolateral, MIS 2-incision, MIS posterior, or lateral transgluteal approach.

Patients with chronic fatigue syndrome performed worse than controls in a controlled repeated exercise study despite a normal oxidative phosphorylation capacity.

Background: The aim of this study was to investigate the possibility that a decreased mitochondrial ATP synthesis causes muscular and mental fatigue and plays a role in the pathophysiology of the chronic fatigue syndrome (CFS/ME).

Methods: Female patients (n = 15) and controls (n = 15) performed a cardiopulmonary exercise test (CPET) by cycling at a continuously increased work rate till maximal exertion. The CPET was repeated 24 h later.

Probing forces of menisci: what levels are safe for arthroscopic surgery.

Purpose: to facilitate effective learning, feedback on performance during arthroscopic training is essential. Less attention has been paid to feedback on monitoring safe handling of delicate tissues such as meniscus. The goal is to measure in vitro probing forces of menisci and compare them with a theoretical maximum probing force (TMPF).

Overview of subtalar arthrodesis techniques: options, pitfalls and solutions.

Background: Subtalar arthrodesis (SA) is the preferred treatment for painful isolated subtalar disease. Although results are generally favourable, analysis of current operative techniques will help optimizing this treatment. The aim was to give an overview of SA-techniques and their pitfalls.

Novel metallic implantation technique for osteochondral defects of the medial talar dome. A cadaver study.

Background And Purpose: A metallic inlay implant (HemiCAP) with 15 offset sizes has been developed for the treatment of localized osteochondral defects of the medial talar dome. The aim of this study was to test the following hypotheses: (1) a matching offset size is available for each talus, (2) the prosthetic device can be reproducibly implanted slightly recessed in relation to the talar cartilage level, and (3) with this implantation level, excessive contact pressures on the opposite tibial cartilage are avoided.

Methods: The prosthetic device was implanted in 11 intact fresh-frozen human cadaver ankles, aiming its surface 0.

Difference in balance measures between patients with chronic ankle instability and patients after an acute ankle inversion trauma.

Neuromuscular control of the ankle is disturbed in patients with chronic ankle instability due to an initial ankle inversion trauma. Static balance is assumed to be a measure for this disturbance. Functional (ankle) scores are another way to evaluate ankle impairment.

Osteotomy and autograft lengthening for intra-articular malunion of the proximal ulna: a case report.

An osteotomy with interposition of iliac crest bone graft and lengthening of the proximal ulna can be used to restore ulnohumeral congruency after a malunited comminuted olecranon fracture treated with figure-of-eight tension band wiring.

Clinical evaluation of a dynamic test for lateral ankle ligament laxity.

The dynamic anterior ankle tester (DAAT) has shown a good reliability in testing anterior talar translation in earlier studies. The goal of the present study was first to evaluate the reliability of the DAAT in a clinical setting and second to analyze its ability to detect increased ligament laxity. In 39 patients with unilateral chronic lateral ankle instability, the anterior talar translation of the affected and non-affected side was measured pre and postoperatively using the DAAT, Telos stress radiographs, and the manual anterior drawer test.

Intra-articular osteotomy for distal humerus malunion.

Intra-articular osteotomy is considered in the rare case of malunion after a fracture of the distal humerus to restore humeral alignment and gain a functional arc of elbow motion. Traumatic and iatrogenic disruption of the limited blood flow to the distal end of the humerus resulting in avascular necrosis of capitellum or trochlea is a major pitfall of the this technically challenging procedure. Two cases are presented which illustrate the potential problems of intra-articular osteotomy for malunion of the distal humerus.

Biomechanical evaluation of fixation of comminuted olecranon fractures: one-third tubular versus locking compression plating.

Introduction: New concepts in plate fixation have led to an evolution in plate design for olecranon fractures. The purpose of this study was to compare the stiffness and strength of locking compression plate (LCP) fixation to one-third tubular plate fixation in a cadaveric comminuted olecranon fracture model with a standardised osteotomy.

Materials And Methods: Five matched pairs of cadaveric elbows were randomly assigned for fixation by either a contoured LCP combined with an intramedullary screw and unicortical locking screws or a one-third tubular plate combined with bicortical screws.

Correlation of DASH and QuickDASH with measures of psychological distress.

Purpose: In an attempt to shorten the questionnaires given to patients in both clinical and research settings, we studied whether the correlation of commonly used psychological measures was comparable for the standard Disabilities of the Arm, Shoulder, and Hand (DASH) and the shorter QuickDASH questionnaires.

Methods: A cohort of 839 patients with carpal tunnel syndrome, trigger finger, de Quervain's disease, trapeziometacarpal arthrosis, lateral epicondylosis, or a distal radius fracture 2 weeks after surgery, who completed the DASH and 1 or more measures of psychological distress, was created from 10 databases from previously implemented studies. Correlations of the DASH and the QuickDASH with several measures of psychological factors (Center for Epidemiologic Studies Depression Scale [CES-D], Pain Catastrophizing Scale [PCS], and Pain Anxiety Symptoms Scale [PASS-40]) were calculated in both univariate and multivariable analyses.

First validation of the PASSPORT training environment for arthroscopic skills.

The demand for high quality care is in contrast to reduced training time for residents to develop arthroscopic skills. Thereto, simulators are introduced to train skills away from the operating room. In our clinic, a physical simulation environment to Practice Arthroscopic Surgical Skills for Perfect Operative Real-life Treatment (PASSPORT) is being developed.

Pulsed electromagnetic fields after arthroscopic treatment for osteochondral defects of the talus: double-blind randomized controlled multicenter trial.

Background: Osteochondral talar defects usually affect athletic patients. The primary surgical treatment consists of arthroscopic debridement and microfracturing. Although this is mostly successful, early sport resumption is difficult to achieve, and it can take up to one year to obtain clinical improvement.