Application of X-ray image measurement in the early diagnosis of sports injury of ankle ligament

Objectives:

To study the value of X-ray analysis method of ankle fracture based on injury mechanism to improve the imaging diagnosis level of ankle fracture.

Methods:

This study was conducted from January 2016 to December 2019. It included 105 cases of fractures caused by sprained ankle joints. Their age was between 21-81 years with an average of 49.5 years, The traditional X-ray analysis method (Group-A) and the injury mechanism-based ankle fracture X-ray analysis method (Group-B) were used to analyze X-ray image data. Group-B also performed Weber classification and Lauge-Hansen classification on cases. Installment.

Results:

Of the 105 patients with ankle fractures, 97 patients in Group-B were able to make Lauge-Hansen classification. Of these 97 ankle fractures, 137 were found in Group-A, and 158 were found in Group-B. The wrong diagnosis of fracture in Group-A was 18%, and the wrong diagnosis of fracture in Group-B was 0.5%. There was a statistically significant difference between the two groups (P <0.05).

Conclusion:

The X-ray analysis method of ankle fractures based on injury mechanism can effectively improve the detection rate of hidden ankle fractures and high fibular fractures, and reduce the missed diagnosis, which is superior to the traditional X-ray analysis methods. At the same time, Weber classification, Lauge-Hansen classification and staging can be made for most cases, which is conducive to guiding clinical treatment.

Predicting mortality for patients with heart failure beyond oxygen consumption: a prognostic risk score

Cardiopulmonary exercise test (CPET) is a crucial tool for the functional evaluation of cardiac patients. We hypothesized that maximal oxygen consumption (V̇o_2max) and ventilatory efficiency-minute ventilation to carbon dioxide production (V̇e/V̇co₂) slope are not the only parameters of CPET able to predict major cardiac events (mortality or cardiac transplantation urgently or elective). We aimed to identify the best CPET predictors of major cardiac events in patients with severe chronic heart failure and to propose an integrated score that could be applied for their prognostic evaluation. We evaluated 140 patients with chronic heart failure who underwent CPET between 2011 and 2019. Major cardiac events were evaluated during follow-up. Univariate and multivariate logistic regression analyses were applied to study the predictive value of different clinical, echocardiographic, and CPET parameters in relation to the major cardiac events. A score was generated, and c-statistic was used for the comparisons. Thirty-nine patients (27.9%) died or underwent cardiac transplantation over a median follow-up of 48 mo. Five parameters (maximal workload, breathing reserve, left ventricular ejection fraction, diastolic dysfunction, and nonidiopathic cardiomyopathy) were used to generate a risk score that had better risk discrimination than the New York Heart Association dyspnea scale, V̇o_2max, V̇e/V̇co₂ slope > 35 alone, and combined V̇o_2max and V̇e/V̇co₂ slope (P = 0.009, 0.004, <0.001, and 0.005, respectively) in predicting major cardiac events. A composite score of CPET and clinical/echocardiographic data is more reliable than the single use of V̇o_2max or combined with V̇e/V̇co₂ slope to predict major cardiac events.NEW & NOTEWORTHY This is a cohort study with a follow-up of maximum of 8 years of patients with chronic heart failure that demonstrates a simple integrated score consisting of CPET (breathing reserve, workload at maximal exercise), echocardiographic (LVEF, diastolic dysfunction), and clinical (etiology of cardiac disease) data. The generated score was a better predictor of major cardiac events (mortality or cardiac transplantation) than Weber classification (V̇o_2max classification) or NYHA functional class as single factors.

A rare case of tibial hemimelia, surgical technique and clinical results

We report a nine-year-old boy with a type IIIa tibial hemimelia, according to the new Paley classification. We describe the x-ray findings, the surgical treatment technique, and the prognostic course of the patient. Descriptions of such cases are very infrequent in the literature and type of treatment is still object of debate.

Temporal Variation in Ankle Fractures and Orthopedic Resident Program Planning in an Urban Level 1 Trauma Center

Previous studies have described the mechanism of ankle fractures, their seasonal variation, and fracture patterns but never in conjunction. In addition, the cohorts previously studied were either not from trauma centers or were often dominated by low-energy mechanisms. The present study aimed to describe the epidemiology of ankle fractures presenting to an urban level 1 trauma center. The records from an urban level 1 trauma center located in the Midwestern United States were retrospectively reviewed, and the injury mechanism and energy, time of injury, day of week, month, and patient characteristics (age, gender, comorbidities, smoking status) were collected. The fractures were classified using the AO (Arbeitsgemeinschaft für Osteosynthesefragen), Lauge-Hansen, and Danis-Weber systems. Of these systems, the Lauge-Hansen classification system resulted in the greatest number of "unclassifiable" cases. Most ankle fractures were due to high-energy mechanisms, with motor vehicle collisions the most common high-energy mechanism. The review found that most ankle fractures were malleolar fractures, regardless of the mechanism of injury. The ankle fracture patients had greater rates of obesity, diabetes, and smoking than present in the region where the hospital is located. The fractures were most likely to occur in the afternoon, with more fractures presenting on the weekend than earlier in the week and more fractures in the fall and winter than in the spring and summer. The temporal variation of these fractures should be considered for health services planning, in particular, in regard to resident physician staffing at urban level 1 trauma centers.

Ankle fractures: Getting it right first time

INTRODUCTION

Ankle fractures are common injuries presenting to trauma departments and ankle open reduction and internal fixation (ORIF²) is one of the first procedures targeted in early orthopaedic training. Failure to address the fracture pattern with the appropriate surgical technique and hardware may lead to early failure, resulting in revision procedures or premature degenerative change. Patients undergoing revision ORIF are known to be at much greater risk of complications and many of these secondary procedures may be preventable.

METHOD

A retrospective analysis of all patients attending our unit for ankle ORIF over a two year period was undertaken. Patients were identified from our Bluespier database and a review of x-rays was undertaken. All patients undergoing re-operation within eight weeks of the primary procedure were studied. The cause of primary failure was established and potential contributing patient and surgical factors were recorded.

RESULTS

236 patients undergoing ankle ORIF were identified. 13 patients (5.5%) returned to theatre for a secondary procedure within eight weeks. Within this group, seven (54%) patients returned for treatment of a neglected or under treated syndesmotic injury, three (23%) for complete failure of fixation, two (15%) with wound problems and one (8%) for medial malleolus mal-reduction. Of the patient group, five (39%) were known type 2 diabetics. Consultants performed two (15%) procedures, supervised registrars five (39%) and unsupervised registrars six (46%) operations.

CONCLUSION

Errors are being made at all levels of training in applying basic principles such as restoring fibula length and screening the syndesmosis intra-operatively. Appropriate placement and selection of hardware is not always being deployed in osteopenic bone resulting in premature failure of fixation and fracture patterns are not being fully appreciated. Patients are undergoing preventable secondary procedures in the operative treatment of ankle fractures.

Systematic radiographic evaluation of tibial hemimelia with orthopedic implications

Tibial hemimelia is a rare lower-extremity pre-axial longitudinal deficiency characterized by complete or partial absence of the tibia. The reported incidence is 1 in 1 million live births. In this pictorial essay, we define tibial hemimelia and describe associated conditions and principles of preoperative imaging assessment for a child with tibial hemimelia. We also indicate the imaging findings that might influence the choice of treatment, describe the most widely used classification systems, and briefly discuss current treatment approaches.

Relationships Between Radiographic Pre- and Postoperative Alignment and Patient Perceived Outcomes Following Weber B and C Ankle Fractures

BACKGROUND

Anatomic reduction of ankle fractures may influence outcomes but the relationships between these 2 variables are still unknown and require further investigation. The purpose of this study was to investigate the relationships between radiologic alignment of surgically treated ankle fractures and functional outcomes.

METHODS

This retrospective study included patients who were surgically treated for Weber B and C ankle fractures. The outcome measures consisted of the Olerud and Molander Ankle Score (OMAS) and the foot and ankle disability measure. Standard radiographs included anteroposterior, lateral, and mortise views of the ankle, both on pre- and postoperatively. Between June 2011 and December 2013, a total of 152 patients were treated for ankle fractures and 76 patients with a mean age of 41.3 ± 17.1 years and a mean follow-up of 39.6 ± 8.9 months were included. There were 45 Weber type B fractures (mean age 43.4 ± 17.8, 28 females, 17 males) and 31 Weber type C fractures (mean age 40.7 ± 17.3, 12 females, 19 males).

RESULTS

Linear regression did not reveal any significant relationships with the exception of age. There was a moderate correlation between the OMAS outcome score and age ( r² = 0.46, P = .01).

CONCLUSION

We found that younger age was a moderate predictor of functional outcome following surgical treatment of ankle fractures. Radiographic alignment using standard non-weight-bearing radiographs and fracture severity did not predict functional outcomes at 24 months postoperatively.

LEVEL OF EVIDENCE

Level III, prognostic, retrospective cohort study.

Association of Body Mass Index With the Pattern of Surgically Treated Ankle Fractures Using Two Different Classification Systems

The present retrospective cohort study assessed the association of body mass index (BMI) with the pattern of ankle fractures using 2 classifications systems. Of the 1011 consecutive patients who underwent surgery for ankle fractures in 2 hospitals from January 2009 to December 2011, 837 had a classifiable fracture according to 1 of 2 classification systems and complete information available for covariates. The association of BMI, adjusted for age, sex, corticosteroid use, diabetes, and smoking status with having a more proximal fibula fracture (Weber class A to C) and an increasing number of malleoli involved (uni-, bi-, or trimalleolar) was assessed using multivariable ordered logistic regression analysis. The mean age of the patients was 50.9 ± 16.9 years, and 461 (55%) were female. On multivariable analysis, BMI and male sex were associated with having a more proximal fibula fracture using the Weber classification, with an odds ratio (OR) of 1.07 (95% confidence interval [CI] 1.04 to 1.11; p < .001) per 1 kg/m² increase and OR of 2.96 (95% CI 2.13 to 4.11; p < .001) compared with female sex, respectively. Age was not associated with this fracture classification. In an analysis of uni-, bi-, and trimalleolar fractures, age per 10 years showed higher odds (OR 1.24, 95% CI 1.14 to 1.36; p < .001) and male sex lower odds compared with female sex (OR 0.36, 95% CI 0.27 to 0.48; p < .001) of having trimalleolar fractures than uni- or bimalleolar fractures. An increasing BMI did not seem to be a risk factor, although an inverse U-shaped relationship was seen between quintiles of BMI and the OR of having trimalleolar versus uni- or bimalleolar fractures. Corticosteroid use, diabetes, and smoking status were not significantly associated with the pattern of the ankle fractures using either classification system. In conclusion, an increasing BMI and male sex were risk factors for proximal fibula fractures, and female sex and age were risk factors for bi- and trimalleolar fractures.

Distal tibiofibular synostosis after surgically resolved ankle fractures: An epidemiological, clinical and morphological evaluation of a patient sample

INTRODUCTION

Ankle fractures comprise a highly morphologically and etiologically diverse group of injuries, which includes various degrees of impairment of bone and ligamentous structures. The complete synostosis and incomplete bony bridging of tibiofibular syndesmosis are among the local late complications after surgically treated ankle fractures.

PATIENTS AND METHOD

269 patients were evaluated, including 203 patients with Weber type-B fractures, and 66 patients with Weber type-C fractures. All patients underwent ankle radiography at standard intervals (post-operatively, 6 and 12 weeks, 6 and 12 months). The final assessment one year after osteosynthesis was performed. The study analyzed age, sex, fracture morphology, the location and morphology of ossification, functional outcomes and subjective evaluations of patient status.

RESULTS

As risk factors there were found male sex, tibiotalar dislocation, syndesmotic screw fixation and Weber type-C fractures. The severity of subjective difficulties and objective status were not dependent on the size of distal tibiofibular synostosis.

DISCUSSION AND CONCLUSION

Despite relatively extensive imaging findings of complete synostosis or incomplete bony bridging, they only limited functional outcomes to a minimal extent.