Bandverletzungen am oberen Sprunggelenk

Ligamentous instability in the ankle frequently leads to chronic synovitis, cartilage lesions and osteophyte formation, which may degenerate into posttraumatic arthritis. Lesions of the distal tibiofibular syndesmosis are significant for the biomechanics of the ankle when the interosseous tibiofibular ligament is ruptured. Accurate reduction of the fibula to reposition it in the tibial incision and temporary fixation with a syndesmosis screw are essential if healing in the anatomical position is to be achieved. For treatment of a chronic instability of the distal tibiofibular syndesmosis anatomical ligamentoplasty is preferred. In the case of acute lateral ankle ligament ruptures conservative-functional treatment has become established over the last 20 years. Recent meta-analyses have failed to demonstrate any clear superiority of operative treatment, which has the potential for considerable complications. Chronic lateral ankle instability has a favorable prognosis with secondary interventions. Anatomical reconstruction should be given priority over extra-anatomical tenodesis procedures, since the latter are associated with considerable functional restrictions. Isolated ruptures of the deltoid ligaments are rare injuries that heal well with conservative-functional treatment after correct diagnosis.     

Arthrodeseverfahren am oberen Sprunggelenk

Tibiotalar arthrodesis remains the gold standard for the treatment of disabling ankle arthritis. The purpose of this article was to review the different techniques of tibiotalar arthrodesis. Most of these techniques represent predictable methods to obtain fusion of the tibiotalar joint. Complications of upper ankle arthrodesis include arthrosis of adjoining joints, nonunion or malunion, nerve, vessel or tendon injury and infection. With precise surgical technique, appropriate postoperative care, and meticulous patient compliance, stability can be restored to the dysfunctional foot. Arthrodesis of the upper ankle can be extremely rewarding for the patient and surgeon.     

Autologe Chondrozytentransplantation am oberen Sprunggelenk

Ankle sprains are one the most common injuries of the lower limb. Fractures, ligamentous lesions, and cartilaginous damage are often associated. Nevertheless the injury is often misjudged and concomitant chondral lesions are assessed late. In the case of a symptomatic osteocartilaginous lesion of the talus, which can be illustrated by MRI or X-ray, operative intervention is indicated. Methods such as microfracturing, mosaicplasty, and autologous chondrocyte transplantation (ACT) are in clinical use. The latter is well known and being established as the treatment of choice for large cartilage defects in the knee. Due to the good results in the knee and the technological improvements (three-dimensional tissue constructs seeded with autologous chondrocytes) this method is being increasingly applied for cartilage lesions of the talus. In contrast to the mosaicplasty donor site morbidity is low and the size of the defect is not a limiting factor. The current studies about ACT of the talus show a stable repair of the defect with mostly hyaline-like cartilage and high patient satisfaction. Therefore, the procedure can be recommended for lesions >1 cm². Concomitant treatment of posttraumatic deformities (malalignment), ligamentous instabilities, and especially the reconstruction of bony defects are compulsory.     

Computerassistierter Teilgelenkersatz am oberen Sprunggelenk

Joint arthroplasty of the upper ankle, unlike procedures in other joints such as the hip, is not an established standardized procedure. Moreover, patients with post-traumatic arthrosis in the upper ankle joint are often young, and hence confronted with immense personal and economic risk. At present, there is only a limited choice of therapy options to address the significant level of suffering experienced by these patients. For this reason, the three fields of tissue engineering, computer-assisted imaging and computer-assisted surgery have been brought together to form an interdisciplinary research approach. A study was undertaken to see whether it would be possible to accurately perform partial replacement of an upper ankle joint following virtual planning using a pre-made bone replacement in a single surgical procedure. To this end, special navigation software for the upper ankle joint was developed and tested on models and cadavers, with very promising results.     

Arthroskopisch assistierte Frakturversorgung am oberen Sprunggelenk

Acute ankle fractures are one of the most common fractures in adults with an incidence of 0.1–0.2?% per year. Operative treatment by open reduction and internal fixation (ORIF) is the standard method of treatment for unstable or dislocated fractures. The main goal of the operation is the anatomical realignment of the joint and restoration of ankle stability; nevertheless, anatomical reduction does not automatically lead to favorable clinical results. According to several studies the mid-term and in particular the long-term outcome following operative treatment is often poor with residual symptoms including chronic pain, stiffness, recurrent swelling and ankle instability. There is growing evidence that this poor outcome might be related to occult intra-articular injuries involving cartilage and soft tissues. In recent studies the frequency of fracture-related osteochondral lesions was reported to be approximately 64?%. By physical examination, standard radiography or even computed tomography (CT), these intra-articular pathologies cannot be reliably diagnosed; therefore, many authors emphasize the value of ankle arthroscopy in acute fracture treatment as it has become a safe and effective diagnostic and therapeutic procedure. Arthroscopically assisted open reduction and internal fixation (AORIF) allows control of the reduction as well examination of all intra-articular structures. If necessary, intra-articular pathologies can be addressed by removing ruptured ligaments and loose bodies, performing chondroplasty or microfracturing. So far there is no evidence that supplementary ankle arthroscopy increases the complication rate. On the other hand, the positive effect of AORIF has also not been clearly documented; nevertheless, there are clear indications that arthroscopically assisted fracture treatment is beneficial, especially in complex fractures.     

Die infizierte Osteosynthese am oberen Sprunggelenk

Background

Should osteosynthesis infection occur after ankle fractures in patients with microangiopathy, the infection needs to be cured quickly and safely to protect implants, bone, and tendons. Vacuum therapy (TNP) provides a perfect treatment plan that keeps the inpatient time low whilst ensuring high patient comfort.

Methods and patients

Four angiopathic patients with deep wound infection after ankle osteosynthesis were treated. At admission, loss of stability and spread of the infection were the immeadiate risks. To prevent this, we treated the patients with vacuum therapy after initial debridement until skin cover was achieved.

Results

In all cases stability was secured and after 2 dressing changes, the swabs were sterile. The inpatient time was 13 days; overall vacuum therapy time was 59 days. Patient satisfaction was high.

Discussion

Vacuum therapy is a perfect strategy after surgical debridement and before secondary mesh grafting. It protects the stability of the bone and open-lying delicate structures in patients with infected osteosynthesis of the ankle and angiopathy and offers an easy, safe, and successful treatment path with a short inpatient time.     

76. Frakturen und Distorsionen am oberen Sprunggelenk

Summary Almost 80% of ankle injuries in sports activities occur in athletics and ball games. 15% of those are contusions, more than 80% ligament lesions and only 2% are fractures. Fractures of the malleoli, the distal tibia and the talus with dislocation are managed surgically by stable internal fixation. Radiographs in forced pronation and/or supination have increasingly become essential in isolated lesions of the anterior fibulotalar ligament with subsequent indication for its surgical repair. Operative management is superior to conservative treatment in its results.     

305. Die anatomiegerechte Bandplastik am oberen Sprunggelenk

Zusammenfassung Bei chronischen Instabilitäten des oberen Sprunggelenks stellt sich die Indikation zum plastischen Bandersatz. Nach Darstellung der anatomischen Verhältnisse werden aus zahlreichen Operationsmethoden 3 beispielhafte Vertreter einer neuen Bandplastik gegenübergestellt. Die mechanischen Verhältnisse werden am Plexiglasfadenmodell demonstriert. In den einleitenden Bemerkungen werden die biomechanischen Grundlagen zur Bandplastik zusammengefasst. Es folgt dann die Demonstration des operativen Vorgehens. Es wird eine längshalbierte Peronaeus-brevis-Sehne in einen u-förmigen Bohrkanal an der distalen Fibula eingezogen. Die Bohrungen werden mit Kirschnerdrähten markiert und mit einem kannelierten Bohrer und einer eigenen Winkelbohrlehre ausgeführt. Die Enden werden am Rande der Insertionsstellen des Lig. talofibulare anterius und calcaneoîibulare fixiert, womit eine anatomische Imitation der natürlichen Bänder gelingt.     

305. Die anatomiegerechte Bandplastik am oberen Sprunggelenk

Zusammenfassung Beim Plattenfixateur interne wird eine winkelstabile Verbindung zwischen dem Schraubenkopf und der Platte dadurch erreicht, dass der Schraubenkopf durch eine zweite kleine Druckplatte fixiert wird. Von Oktober 1985-November I986 führten wir in 56 Fällen eine dorsale Spondylodese mit dem Plattenfixateur durch. Dieses System zeichnet sich durch eine kurze Operationszeit und einfache Handhabung sowie eine höhere mechanische Festigkeit gegenüber anderen Systemen aus. Die transpedunculäre Spongiosaplastik lässt sich bei liegender Platte durchführen, ebenfalls ist die Fixation des verletzten Wirbelsegmentes möglich.     

Problematik der fehlgeschlagenen Endoprothese bei posttraumatischer Arthrose am oberen Sprunggelenk

Trauma und Berufskrankheit - Die posttraumatische Arthrose des oberen Sprunggelenks (OSG) stellt noch immer eine Herausforderung in der operativen Versorgung dar. Während bei frustranem...     

243. Die chronische anterolaterale Instabilität am oberen Sprunggelenk

Zusammenfassung 1972–1978 wurden an der Medizinischen Hochschule Hannover 43 fibulare Bandplastiken durchgeführt; 36 nachuntersucht. In 22 Fällen wurde eine modifizierte Evans-Plastik angewandt: Die distal gestielte Peronaeus brevis-Sehne wird halb gespalten bis auf Höhe des prox. Retinaculums, dort nach ventral durch den Außenknöchel geführt und u. h. davon in sich vernäht. Radiologisch wurden prä- und postoperativ gehaltene standardisierte Aufnahmen vom OSG in 2 Ebenen angefertigt. Nach 20 klinischen und 3 radiologischen Parametern waren 30 Plastiken sehr gut bis gut, 6 befriedigend.     

Behandlungsergebnisse nach operativer versorgung firscher Außenbandverletzungen am oberen Sprunggelenk

105 patients with acute injuries of the fibular collateral ligament were treated surgically. Diagnoses and following treatment were based on X-rays in stressed positions (talar tilt and anterior drawer sign) compared with the other side. More than fifty percent were athletic injuries. After surgical treatment patients wore a below-knee plaster cast for 6 weeks. 90 patients were seen after an average interval of 24 months; another 7 were assessed on the basis of patient's judgement. In 7 cases the X-ray control showed some instability (talar tilt>5^o and anterior drawer sign>2 mm). At physical examination we found in some cases minor differences in mobility, swelling and pain. 14 patients showed hypesthesia on the lateral side of the dorsum of the foot. No patient had to give up his sport activitees due to the ligamentous injury, 89 (97 were asked) were content with the result.     

Therapie und Ergebnisse der frischen lateralen Instabilität am oberen Sprunggelenk

During a retrospective study we especially examined the late outcome in therapy of injuries of the lateral capsula ligament-lesions in 210 patients. In addition we scrutinized the literature on this subject within the last 60 years, concerning the results of different therapy methods were checked. 203 collective writings on this subject, 23279 patients and our own results achieved in the BG Accident Hospital in Murnau (Germany) all added up to 23389 patients. We did not only observe the subjective opinion regarding the outcome of the therapy but also the socio-economic factors, such as the duration of incapability to work and do sports. Emphasis was laid on the remaining complaints: reduction of movement, swelling, pain during stress and instability (in the sense of recurring injuries). The results of this thesis show the dependence of the therapy in respect to the age of the patient. So we have developed a different therapy-concept for those under age of 30 and for those over the age of 30 years.