Haemarthros of the upper ankle joint (author's transl)

34 patients with isolated, non-dislocated fractures of the medial malleolus and consecutive haemarthros of the upper ankle joint were followed up at an average of 8 years after the trauma. Special attention was given to arthrotic deformities and complaints. The results of this study seem to point to the conclusion that postraumatic haemarthros itself is of no special importance in the development of arthrotic changes of the upper ankle joint in man. This was judged from the pathophysiological reactions of articular cartilage due to haemarthros as shown in animal experiments.     

Results of arthrodesis of the ankle joint (author's transl)

We present a check-up study of 47 arthrodeses of the ankle joint, partly in combination with an arthrodesis of the subtalar joint. By resection-compression-arthrodesis following Charnley-Horwitz-Adams we reached a bony fusion of the ankle joint in all cases. 83% of our cases showed a good or at least fair result. The remaining patients complained of painful walking in spite of orthopaedic shoes. In these cases a further fusion of subtalar joints especially of the talo-navicular joint should be considered.     

Results of surgery of lesions of the ankle joint (author's transl)

Ruptures of the ligaments are getting more and more frequent as a result of increased general sports activities and the increasingly high demands made on sportsmen in competitive events. From June 1975 to June 1980, surgery was performed in 76 patients of our hospital. 54 patients were followed up, corresponding to 71% of the total number. 50 patients considered the results of surgery to be very good to good. Four patients only were dissatisfied. This subjective result was confirmed by objective examination. Basing on these data, the conclusion is that surgical treatment of ruptures of the outer ligaments of the ankle joint is the method of choice.     

Indications for surgery in ruptures of ankle joint ligaments (author's transl)

X-ray films of the forced extreme joint position are required for diagnosis of lateral ligamentous injuries of the ankle joint. These x-ray films must be taken in forced extreme joint position in two planes (a.p. and lateral planes) by means of a special holding device simulating the mechanism of trauma by supination, inversion and adduction of the ankle joint by plantar flexion of the foot. If there is a 5 degree difference in talar tilt angle or a 5 mm difference in talar subluxation, an operation is indicated to prevent post-traumatic weak ankle and early arthrosis following chronic instability.     

Late results of arthrodeses of the upper ankle joint

Arthrodesis may be mandatory after destruction or painful arthrosis of the ankle joint. The time at which this should be performed, as well as the technique to be employed, are both judged differently by various writers. We used exclusively the fixateur externe for stabilisation with 44 arthrodeses of the ankle joint, since this ensures stability during exercise and partial load. The complications recorded were two aseptic necroses of the talus and dysostosis in two cases which required corrective surgery. The results obtained by use lead us to the following conclusions: More than one-half of the examined subjects wore the orthopaedic made-to-measure shoes for longer than one year compensating the leg shortening by an average of 1.0 cm. The intraoperatively attempted repositioning of the talus in relation to the axis of the tibia tended to have a rather negative effect in our patients. The at least equal long-term results of early and late arthrodeses indicate that early arthrodeses are preferable, seeing that 55.8% of the followed-up persons were able to resume their professional activities relatively quickly.     

Results of surgically treated luxation fractures of the upper ankle joint (author's transl)

113 patients were followed up after an average period of 27.2 months postoperatively following surgical treatment of luxation fractures of the ankle joint, from a closed series of 200 operations carried out in accordance with AO principles. Unsatisfactory late results were found in Type C in 38.6% of the cases, in the total group in 29.2% of the cases. The rate of infection was about 2%. One-third of the poor results were due to pre-arthrotic deformities or damages due to accidents; over and above this, surgico-technical complications led to unsatisfactory treatment results.     

Ball and socket ankle joint and tarsal synostosis (author's transl)]

Ball and socket ankle joints in 4 patients with "tarsal coalition" have first been described by Lamb and later by others. This report deals with a further case. The boy with a congenitally short left leg and absence of the lateral two toes was seen at the age of 4 months. He was again seen at 11 years of age after a sprain of the right ankle. Roentgen-examination showed calcaneotarsal synostosis and a ball and socket ankle joint with a fatigue fracture of the lateral metatarsal. The shape of the ankle joint appears to be part of a non-inheritable congenital defect with early embryonal disturbance of cleft formation in the tarsus.     

Subtalar joint alignment in ankle osteoarthritis

Background

Although it has been proposed that in mid-stage ankle osteoarthritis, the subtalar joint can compensate for deformities above the ankle joint, the evidence is weak. We thus investigated subtalar joint alignment in different stages of ankle osteoarthritis using weightbearing computed tomography (CT) scans.

Biomechanics, technique and results of fibular ligamentous grafting at the ankle joint (author's transl)

The grafting operations according to Watson-Jones and Evans in old fibular capsular ligament lesions of the ankle joint have the effect of tenodesis as far as the talo-calcaneo-navicular joint ist concerned, since especially the natural course of the ligamentum calcaneofibulare, which requires substitution, is not considered. The authors conducted a search for the most favourable course when replacing the ligamenta talofibulare anterius and calcaneofibulare, using a thread model on ankle joint preparations. It is only the direct replacement of these ligaments which is most likely to ensure free mobility of ankle joint and the talo-calcaneonavicular joint with optimal joint stabilization. Courses proceeding differently will lead either to tenodesis or to slackening of the ligamentous replacement without producing a stabilizing effect. From the author's own patient, two groups with anatomically compatible ligamentous replacement with lyodura (n = 12) or with a modified graft of the short peroneal muscle (n = 8) were compared with each other. In accordance with the experimental results, the main difference between the two processes was the restriction in supination of the talo-calcaneo-navicular joint. The authors conclude from their results that duraplasty, which follows the anatomical course of the ligaments to be replaced, is indicated particularly in such patients who require free supination of the foot because they are active in certain types of sport where this is essential.     

Results of surgical treatment of 248 lateral ligamentous lesions of the ankle joint (author's transl)

From 1975 to 1980, 414 patients suffering from lateral ligamentous lesions of the ankle joint had undergone surgical treatment. 248 patients were seen in two follow-up examination; of these, 122 patients were examined by x-ray films taken in forced extreme joint position in two planes (a.p. and lateral) of both ankle joints, the uninjured ankle being examined for comparison. In 76.2% of the cases, both ankle joints were found to possess equal stability. Less than 10% of the follow-up patients examined showed slight restriction in mobility of the upper ankle joint. 97% of the patients questioned stated that the results of surgery were good. Only 3% expressed dissatisfaction. A severe complication was observed in 1 patient, who had an infection of the joint; cure was effected by means of arthrodesis of the upper ankle joint.     

Biomechanical investigations of the ankle joint after shortening of the distal end of the fibula (author's transl)

Shortening of the distal fibula after malleolar fracture is accompanied with important alterations of the biomechanics and the compressive forces of the ankle joint. The relationship between the extent of shortening, the degree of valgus position of the talus and the reduction of the joint surfaces is described on the basis of experimental investigations. The importance of these circumstances for treatment of malleolar fractures is discussed.     

Diagnosis of the acute injuries of the lateral ankle joint ligaments with a new holding device (author's transl)

In one year 437 patients with acute injuries of the ligaments of the lateral ankle joint were examined with a new simple holding device to ensure accurate diagnosis. The rupture is demonstrated by standardized and reproducible stress X-rays. Comparing the instability of the injured side with the contralateral health ankle joint the difference indicates the type and the extent of the injury. In 232 cases (53%) we found a "sprained ankle" and in 205 cases (47%) ruptured ligaments.     

Comments on pseudarthrosis of the cuneonavicular joint (author's transl)

This paper reports on the result of central bone chip bolting in the treatment of pseudarthrosis of the cuneonavicular joint, using an autologous bone chip according to the method evolved by Wilhelm and Sperling. The surgical procedure and postoperative course are described in detail, as well as the findings of a followup check effected two years later.