Overuse of concomitant foot radiographic series in patients sustaining minor ankle injuries

Radiographic series of the foot are often obtained in conjunction with ankle X-rays when the clinical presentation is limited to trauma to the ankle. The Ottawa Ankle and Foot Rules were established in 1992 and serve as reliable guidelines to determine when an ankle or foot series is warranted in patients who have sustained minor ankle and/or foot injury. We retrospectively reviewed radiographic studies of all patients over a period of 18 months who simultaneously had ankle and foot plain radiographs performed for acute complaints limited to the ankle alone. Of the 243 patients who met our inclusion criteria, 55 patients had fractures, 46 in or near the ankle joint, and nine which were located at the base of the fifth metatarsal bone. No fractures or dislocations were noted elsewhere in the foot. All of the fifth metatarsal fractures were evident on adequately performed ankle series. Our findings suggest that films of the foot are not necessary when trauma is limited to the ankle and when an appropriately performed ankle series has been completed.     

Abnormal internal anal sphincter fibrosis and elasticity in fecal incontinence

PURPOSE: We aimed to investigate the changes in the proportion of collagen and in the elasticity of the internal anal sphincter in patients with neurogenic fecal incontinence. METHODS: Collagen content was studied in ten patients with neurogenic fecal incontinence (mean age, 51.5 years) and ten controls (age, 58.6 years) using histologic techniques to determine differences between incontinence and health and to determine the effect of aging. Changes in elasticity were also measured in 8 controls (mean age, 63 years) and 13 patients with neurogenic incontinence (mean age, 60 years) by recording the in vitro length-tension relationship of the freshly excised internal anal sphincter. RESULTS: Incontinent patients had a significantly higher collagen content than controls (55 percent vs.33 percent;P=0.013). In incontinent patients the amount of collagen and the patients' ages correlated significantly (P=0.001). There was a greater increase in stable tension per increase in muscle length in the strips from incontinent patients compared with controls. CONCLUSIONS: Changes in fibrous tissue content are likely to influence muscle tone and responsiveness of the sphincter in fecal incontinence.C. T. M. Speakman was supported by the Sir Alan Parks Research Foundation, The Royal College of Surgeons, and M. A. Kamm was supported by the St. Mark's Research Foundation.