Neuropathic ankle fractures

A 65-year-old diabetic female presented with a 3-week history of a left swollen foot after a minor inversion injury and was found to have a minimally displaced fibular fracture. Despite casting and strict instructions to remain non-weight bearing, the patient continued to bear weight and later developed a significantly more displaced fracture with a draining ulcer. This injury eventually required a tibiotalocalcaneal arthrodesis using a retrograde hindfoot nail. Neuropathy and neuropathic fractures can be devastating complications of diabetes and thus require early diagnosis and intervention because they may result in significant morbidity for the patient. Thorough assessment involving imaging, a complete history and physical examination, and tools such as a 129 Hz tuning fork and the 10 g Semmes-Weinstein monofilament are paramount to establishing an accurate initial diagnosis. These tactics aid in future follow-up of the patient's injury and can be employed in both the clinic and the emergency department. Although management remains controversial for neuropathic ankle fractures because both conservative and surgical treatment regimens have high complication rates, open reduction and internal fixation continues to be the treatment of choice once closed reduction has been attempted and fails. Education is essential because diabetic patients have compromised pain and pressure sensation, which can lead to injuries and subsequent complications of which they are simply unaware. Physicians must be diligent when evaluating the diabetic foot and be explicit when providing instructions to these patients because preventing these injuries and their complications is the best patient care available.     

Foot fractures frequently misdiagnosed as ankle sprains

Most ankle injuries are straightforward ligamentous injuries. However, the clinical presentation of subtle fractures can be similar to that of ankle sprains, and these fractures are frequently missed on initial examination. Fractures of the talar dome may be medial or lateral, and they are usually the result of inversion injuries, although medial injuries may be atraumatic. Lateral talar process fractures are characterized by point tenderness over the lateral process. Posterior talar process fractures are often associated with tenderness to deep palpation anterior to the Achilles tendon over the posterolateral talus, and plantar flexion may exacerbate the pain. These fractures can often be managed nonsurgically with nonweight-bearing status and a short leg cast worn for approximately four weeks. Delays in treatment can result in long-term disability and surgery. Computed tomographic scans or magnetic resonance imaging may be required because these fractures are difficult to detect on plain films.     

快速诊断规则用于鉴别足踝扭伤有无骨折的临床分析

目的探讨应用快速诊断规则（OAR）鉴别足踝扭伤伴骨折的漏诊原因,指导OAR的合理应用。方法选择2005年3月至2010年3月在泸州医学院外科门诊就诊的足踝扭伤患者,应用OAR进行临床检查并做出有无骨折的判断,于受伤后24h内和第15天进行足踝x线摄片,验证OAR诊断结果的准确性。结果根据OAR原则,踝关节扭伤105例中初步诊断16例合并骨折,经x线检查合并骨折17例,漏诊1例（6．2％）;足扭伤50例患者中21例合并骨折,OAR原则与x线摄片诊断结果一致。结论OAR对足踝扭伤并骨折的判断准确率高,但也有漏诊的可能,临床要警惕。     

踝部骨折切开复位术后康复训练

Background:Ankle joint is a weight carrying one,which treatment focuses on anatomical reduction of articular surface.The ultimate aim is completely recovery of joint function.It is much benefit for open reduction with rational rehabilitation training of post operation to function recovery of ankle joint.     

Assessment and management of foot and ankle fractures

Injuries to the foot and ankle are common presentations in A&E, and while these are rarely life-threatening, incorrect diagnosis and management can have serious consequences for patients. This article discusses the causes, assessment and treatment of patients with these fractures.     

糖尿病患者踝关节骨折的手术治疗

[目的] 探讨合并糖尿病的踝关节骨折的处理及手术方式.[方法] 回顾分析2005年2月至2010年2月收治的95例踝关节骨折的患者,根据是否合并糖尿病而将病例分为糖尿病骨折组（37例）及对照组（58例）,比较两组术后出现感染、骨髓炎、骨折延迟愈合及内固定松动等并发症的几率.[结果] 随访10~21（14.3±2.4）个月,糖尿病骨折组术后各项并发症的出现的几率与对照组比较,无显著性差异（P〉0.05）.[结论] 围手术期合理控制血糖和合适的手术方式,可以减少合并糖尿病的踝关节骨折术后并发症.     

踝部骨折的手术治疗

目的：总结应用内、外踝纵行切口，治疗Ⅲ、Ⅳ度旋前-外旋型踝部骨折的经验和疗效。方法：于1997年7月～2003年4月，对56例Ⅲ、Ⅳ度旋前-外旋型踝部骨折病人采用内、外踝纵行切口进行手术。操作按照从外踝→内踝→后踝的顺序进行。外踝或腓骨骨折用钢板或克氏针张力带固定，用1枚螺钉通过腓骨、胫骨固定下胫腓关节；内踝骨折使用l枚或2枚松质骨加压螺钉或克氏针张力带固定；后踝行加压螺丝钉固定。对下胫腓韧带联合等所有断裂韧带均予以修复。结果：其中45例随访3～5年，根据Leed’s临床评定标准，优33例，占73％；良9例，占20％；优良率93％。差3例，占7％。结论：踝部骨折内外侧路径安全，易行。用此方法治疗Ⅲ、Ⅳ度旋前-外旋型踝部骨折，成功率高，并发症少。     

用一种新型加压螺钉治疗踝关节骨折

作者用一种自行设制的新型加压螺钉治疗各种类型的踝关节骨折,采用改良式的 ccdell方法,从主观、客观及放射学三方面加以综合评价,结果显示:该加压螺钉具有固定牢靠,加压等优点,不仅可促进骨折愈合,而且能有效地纠正腓骨短缩移位,允许早期关节功能锻练,促进关节功能恢复。     

ED point-of-care ultrasound in the diagnosis of ankle fractures in children

In pediatric ankle injury, radiography is the current standard used to differentiate fracture from ligamentous injury; however, the associated cost, increased time, and radiation exposure pose a significant downside to this imaging modality. Point-of-care ultrasound may be an attractive alternative in this setting, as illustrated by this patient case. A 14-year-old boy presented to the emergency department with a left ankle inversion injury sustained while playing soccer. An emergency physician performed ultrasound examination that revealed findings consistent with a nondisplaced Salter-Harris I fracture of the distal fibula. The results of a formal radiograph confirmed this diagnosis. This case report presents the successful use of point-of-care ultrasound for detection of a Salter-Harris I ankle fracture, describes a stepwise approach for this new diagnostic technique in detail, and discusses its value in the setting of pediatric ankle injury.     

足踝药浴加按摩治疗踝关节骨折中后期患者的疗效

目的观察足踝药浴加按摩治疗踝关节骨折中后期的疗效,探讨影响其疗效的相关因素及护理方法。方法将2009年6月至2011年12月收治的踝关节骨折中后期患者共76例,按随机数字表法随机分为对照组和观察组。对照组行活血化瘀药物内服、足踝温水浴及功能锻炼,观察组给予足踝中药浴、按摩后行功能锻炼。结果两组治疗第10天疼痛、功能、活动度的改善程度即开始出现差异[（14．86±7．21）比（8．68±8．98）,（7．18±1．91）比（4．34±1．66）,（2．84±1．46）比（1．97±1．17）;t分别为3．31,6．90,2．85;P〈0．05],第20天疗效统计观察组的优良率为92．10％,对照组为71．06％,两组比较差异有统计学意义（u=2．07,P〈0．05）。结论足踝药浴加按摩使气血通畅,从而达到舒筋通络、祛风散寒、活血化瘀、消肿止痛的作用,能促进踝关节功能的康复。     

Sonographic detection of occult fractures in the foot and ankle.

PURPOSE: The purpose of this retrospective study was to determine whether high-resolution sonography can aid in the diagnosis of radiographically occult fractures in the foot and ankle. METHODS: High-resolution sonography with a 10-MHz linear-array transducer was performed in 268 patients with foot and ankle injuries whose initial plain x-ray films were negative for fracture. RESULTS: Twenty-four patients had occult fractures demonstrated by sonography. On sonography, the occult fractures appeared as a discontinuity of cortex echogenicity. The fractures were found at the calcaneus (n = 8), metatarsus (n = 6), talus (n = 3), navicular bone (n = 3), cuboid bone (n = 2), cuneiform bone (n = 1), and lateral malleolus (n = 1). Review of the patients' radiographs revealed tiny fractures at the sonographically identified locations in 2 patients. The first 5 patients underwent bone scans, which confirmed the presence of the fractures. The first 11 patients received follow-up sonographic examination 6 weeks after diagnosis; in all 11, an echogenic line over the previous fracture site, presumably representing callus formation, was noted. CONCLUSIONS: Sonography-a readily available, noninvasive imaging technique-can provide important information about soft tissue injuries and cortical discontinuities in the foot and ankle area. Using this procedure, occult fractures can be identified and delineated, and costly procedures such as MRI can be avoided.     

可吸收螺钉治疗三踝骨折的临床应用

目的采用可吸收螺钉（PDLLA）治疗三踝骨折,探讨其治疗三踝骨折的临床效果。方法对我院2000年1月至2004年12月采用可吸收螺钉治疗32例三踝骨折患者进行回顾性研究分析。结果全部病例均获随访,骨折愈合时间平均10周,所有病例均愈合且无移位,术后优良率达93．8％,无毒性及过敏反应。结论可吸收螺钉是治疗三踝骨折理想的内固定物,可进一步推广应用。     

严重踝关节骨折脱位手术治疗62例临床分析

目的探讨严重踝关节骨折脱位的手术治疗方法及效果。方法回顾性分析1998年2月至2005年12月我院手术治疗严重踝关节骨折脱位62例患者的临床资料。结果62例全部获得随访，随访时间6个月至32个月，优38例，良14例，可7例，差3例，优良率82％。结论早期手术、外踝及腓骨下段的整复固定、胫腓联合复位固定、早期合理的功能锻炼是提高疗效，减少和预防创伤性关节炎的关键。     

踝关节后踝骨折内固定治疗的疗效分析

目的分析探讨内固定治疗踝关节后踝骨折的临床效果。方法收集2005年10月至2010年12月期间踝关节后踝骨折患者共26例,采用微创空心螺钉内固定法治疗,并对其疗效进行分析。结果术后随访时间为11个月至67个月,平均随访时间为23.4个月。所有病例骨折均获得骨性愈合,临床愈合时间为10~16周,平均愈合时间为13.2周。根据疗效评定标准,其中优15例,良8例,可2例,差1例,优良率为88.46%。结论采用微创空心螺钉内固定法治疗踝关节后踝骨折符合生物力学要求,且该手术操作简单、创伤小、恢复快,是治疗踝关节后踝骨折较为理想的方式。