Category: Ankle Introduction/Purpose: Posterior malleolus fractures (PMFs) occur up to 50% of ank... more Category: Ankle Introduction/Purpose: Posterior malleolus fractures (PMFs) occur up to 50% of ankle fractures. Several classification systems exist for their characterization, specially under computed tomography (CT). However, those classifications do not report or report incompletely the level of agreement and reliability. Also, there are no studies that have validated those classifications further. The aim of this study was to perform an independent agreement study for comparing the level of agreement of Haraguchi, Bartonícek/Rammelt, and Mason's classification; among physicians with different levels of orthopaedic training in the management of PMFs. Methods: This study was designed according to the 'Guidelines for Reporting Reliability and Agreement Studies' ('GRASS'). Ninety-four CT scans of patients with ankle fractures that had PMF were included. Exclusion criteria were previous history of fracture, surgery, tumors, and infections of the ankle; and the pres...
Resumen Objetivo Describir el uso de los cuestionarios reportados por pacientes (patient-reported... more Resumen Objetivo Describir el uso de los cuestionarios reportados por pacientes (patient-reported outcome measures, PROMs, en inglés) en cirugía de tobillo y pie en Chile. Materiales y métodos Estudio descriptivo, transversal, en el que se diseñó y se aplicó una encuesta para conocer el uso de PROMs en Chile. Se invitó a participar a los traumatólogos cuya actividad principal fuese la cirugía de tobillo y pie. Resultados En total, 73 de 110 traumatólogos contestaron la encuesta. El 75% de los encuestados ha utilizado PROMs al menos una vez, y el 50% los utiliza de manera regular. La finalidad con la que se utilizan es principalmente de investigación (83%), y su aplicación es realizada la mayoría de las veces por los médicos del equipo (94%). Se identificaron 15 cuestionarios distintos aplicados en nuestro medio, siendo los más utilizados la Escala Visual Análoga (EVA), la Escala de Tobillo y Retropié de la American Orthopaedic Foot and Ankle Society (AOFAS), el 36-item Short Form He...
Revista Española de Cirugía Ortopédica y Traumatología (English Edition), 2017
Objective: To present a case report of bilateral posterior tarsal tunnel syndrome (PTTS) caused b... more Objective: To present a case report of bilateral posterior tarsal tunnel syndrome (PTTS) caused by an accessory flexor digitorum longus (AFDL), including the surgical technique and a review of the literature. Materials and methods: Twenty-nine year old male diagnosed with bilateral PTTS, refractory to conservative management, with 53 points on the preoperative AOFAS score. MR of both ankles showed an AFDL within the tarsal tunnel, in close relationship to the posterior tibial nerve. Bilateral tarsal tunnel decompression and AFDL resection was performed. Results: There were no post-operative complications. At 6 months after surgery, the patient had no pain and had 87 points on the AOFAS score. Discussion: The PTTS is an entrapment neuropathy of the posterior tibial nerve or one of its terminal branches. A rare cause is the presence of an AFDL, and its resection is associated with good clinical results. Careful scar tissue resection and neurolysis is recommended. Knowing the normal pathway and anatomical variability of the posterior tibial nerve and its branches is essential to avoid iatrogenic injury. In our case report, MR and intraoperative findings identified a bilateral FDLA in close relationship to the common flexor digitorum, an unusual finding, with few reports in current literature. Conclusions: Careful tarsal tunnel decompression and AFDL resection in our patient with bilateral symptomatic PTTS has good clinical results and no complications, particularly when diagnosed and treated early.
Category: Ankle, Trauma Introduction/Purpose: Dislocation of the proximal tibiofibular joint (PTF... more Category: Ankle, Trauma Introduction/Purpose: Dislocation of the proximal tibiofibular joint (PTFJ) in association with ankle fracture is an infrequent injury. The mechanism involves a pronation-external rotation injury in which the energy exits through the PTFJ instead of the proximal fibula, like in a Maissoneuve fracture. Early diagnosis and treatment is of paramount importance to avoid complications such as pain, posterolateral knee instability and peroneal nerve injury due to chronic traction by the dislocated fibular head. In addition, an anatomical reduction of the PTFJ is mandatory to restore the fibular length in order to obtain anatomic reduction at the ankle. The objective is to report 3 cases with PTFJ dislocation in association with ankle fracture and to provide a treatment guide based on the management of these patients. Methods: Three cases of PTFJ dislocation in association with ankle fracture, surgically treated in our institution between 2009 and 2016, were retrosp...
Category: Ankle Introduction/Purpose: Posterior malleolus fractures (PMFs) occur up to 50% of ank... more Category: Ankle Introduction/Purpose: Posterior malleolus fractures (PMFs) occur up to 50% of ankle fractures. Several classification systems exist for their characterization, specially under computed tomography (CT). However, those classifications do not report or report incompletely the level of agreement and reliability. Also, there are no studies that have validated those classifications further. The aim of this study was to perform an independent agreement study for comparing the level of agreement of Haraguchi, Bartonícek/Rammelt, and Mason's classification; among physicians with different levels of orthopaedic training in the management of PMFs. Methods: This study was designed according to the 'Guidelines for Reporting Reliability and Agreement Studies' ('GRASS'). Ninety-four CT scans of patients with ankle fractures that had PMF were included. Exclusion criteria were previous history of fracture, surgery, tumors, and infections of the ankle; and the pres...
Resumen Objetivo Describir el uso de los cuestionarios reportados por pacientes (patient-reported... more Resumen Objetivo Describir el uso de los cuestionarios reportados por pacientes (patient-reported outcome measures, PROMs, en inglés) en cirugía de tobillo y pie en Chile. Materiales y métodos Estudio descriptivo, transversal, en el que se diseñó y se aplicó una encuesta para conocer el uso de PROMs en Chile. Se invitó a participar a los traumatólogos cuya actividad principal fuese la cirugía de tobillo y pie. Resultados En total, 73 de 110 traumatólogos contestaron la encuesta. El 75% de los encuestados ha utilizado PROMs al menos una vez, y el 50% los utiliza de manera regular. La finalidad con la que se utilizan es principalmente de investigación (83%), y su aplicación es realizada la mayoría de las veces por los médicos del equipo (94%). Se identificaron 15 cuestionarios distintos aplicados en nuestro medio, siendo los más utilizados la Escala Visual Análoga (EVA), la Escala de Tobillo y Retropié de la American Orthopaedic Foot and Ankle Society (AOFAS), el 36-item Short Form He...
Revista Española de Cirugía Ortopédica y Traumatología (English Edition), 2017
Objective: To present a case report of bilateral posterior tarsal tunnel syndrome (PTTS) caused b... more Objective: To present a case report of bilateral posterior tarsal tunnel syndrome (PTTS) caused by an accessory flexor digitorum longus (AFDL), including the surgical technique and a review of the literature. Materials and methods: Twenty-nine year old male diagnosed with bilateral PTTS, refractory to conservative management, with 53 points on the preoperative AOFAS score. MR of both ankles showed an AFDL within the tarsal tunnel, in close relationship to the posterior tibial nerve. Bilateral tarsal tunnel decompression and AFDL resection was performed. Results: There were no post-operative complications. At 6 months after surgery, the patient had no pain and had 87 points on the AOFAS score. Discussion: The PTTS is an entrapment neuropathy of the posterior tibial nerve or one of its terminal branches. A rare cause is the presence of an AFDL, and its resection is associated with good clinical results. Careful scar tissue resection and neurolysis is recommended. Knowing the normal pathway and anatomical variability of the posterior tibial nerve and its branches is essential to avoid iatrogenic injury. In our case report, MR and intraoperative findings identified a bilateral FDLA in close relationship to the common flexor digitorum, an unusual finding, with few reports in current literature. Conclusions: Careful tarsal tunnel decompression and AFDL resection in our patient with bilateral symptomatic PTTS has good clinical results and no complications, particularly when diagnosed and treated early.
Category: Ankle, Trauma Introduction/Purpose: Dislocation of the proximal tibiofibular joint (PTF... more Category: Ankle, Trauma Introduction/Purpose: Dislocation of the proximal tibiofibular joint (PTFJ) in association with ankle fracture is an infrequent injury. The mechanism involves a pronation-external rotation injury in which the energy exits through the PTFJ instead of the proximal fibula, like in a Maissoneuve fracture. Early diagnosis and treatment is of paramount importance to avoid complications such as pain, posterolateral knee instability and peroneal nerve injury due to chronic traction by the dislocated fibular head. In addition, an anatomical reduction of the PTFJ is mandatory to restore the fibular length in order to obtain anatomic reduction at the ankle. The objective is to report 3 cases with PTFJ dislocation in association with ankle fracture and to provide a treatment guide based on the management of these patients. Methods: Three cases of PTFJ dislocation in association with ankle fracture, surgically treated in our institution between 2009 and 2016, were retrosp...
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