scholarly journals Fracture of the posterior malleolus: an underdiagnosed condition

2017 ◽  
Vol 3 (2) ◽  
pp. 310
Author(s):  
Luís D. Silva ◽  
Bruno Maia ◽  
Eduardo Cruz Ferreira ◽  
Filipa Pires ◽  
Luís Camarinha
Keyword(s):  
Differential Diagnosis ◽  
Clinical Examination ◽  
Ankle Sprain ◽  
Conventional Radiography ◽  
Ankle Sprains ◽  
Sports Activity ◽  
Posterior Malleolus ◽  
Isolated Fracture ◽  
Low Incidence

<p class="abstract">The ankle joint is the most commonly injured joint during sports activity. While ankle sprains occur more frequently, ankle fractures are less common. Due to its low incidence, the isolated fracture of the posterior malleolus still represents a diagnosis challenge. This article reports a case of a female with a posterior malleolus isolated fracture after falling while performing sports activity. Clinical examination and conventional radiography were consistent with diagnosis of a simple ankle sprain and the patient was discharged with a conservative approach for lateral ankle sprain. Due to persistent pain the patient return for additional examination, which the differential diagnosis revealed an isolated fracture of the posterior malleolus without displacement of the fragment. The patient was immobilized with a suropodalic splint for 4 weeks followed by additional conservative. At the fourth month of follow-up, the patient was asymptomatic and showed good clinical and functional outcomes. This case highlights the importance of a comprehensive medical history and detailed clinical examination which may reveal pathological features that require a differential diagnosis<span lang="EN-IN">.</span></p>

scholarly journals The Diagnostic Value of MRI for High Ankle Sprains with an Unstable Syndesmosis: Time to Scan Matters

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0029
Author(s):  
Daniel Marsland ◽  
Matthew Randell ◽  
Emma Ballard ◽  
Ben Forster ◽  
Michael Lutz
Keyword(s):  
Ankle Sprain ◽  
Ankle Sprains ◽  
Chronic Patients ◽  
Mri Scan ◽  
Posterior Malleolus ◽  
Syndesmosis Injury ◽  
Mri Characteristics ◽  
High Ankle Sprain ◽  
Acute Patients ◽  
Bone Oedema

Category: Ankle, Arthroscopy, Sports, Trauma Introduction/Purpose: Early clinical examination combined with MRI following a high ankle sprain allows accurate diagnosis of syndesmosis instability. However, patients often present late, and for chronic injuries clinical assessment is less reliable. The aims of the current study were to describe MRI characteristics associated with diagnosed syndesmosis instability, and to assess if MRI characteristics change as the injury becomes chronic. Methods: Patients with a high ankle sprain and proven syndesmosis instability at arthroscopy were retrospectively identified from the logbooks of two fellowship trained foot and ankle surgeons over a five-year period. Patients were excluded if they had a distal fibula fracture or absence of an MRI report by a consultant radiologist. Associations between MRI characteristics and time from injury to MRI scan, categorised as acute (< 6 weeks), intermediate (6-12 weeks) and chronic (> 12 weeks) were examined using the Pearson’s chi-squared or Fisher’s exact tests (significance set at p<0.05). Results: Of the 164 patients, 108 had an MRI scan in the acute period, 32 were classified as intermediate and 24 as chronic. A posterior syndesmosis injury was detected in 93.5% of acute patients, 87.5% of intermediate patients and 54.2% of chronic patients. In the acute group, PITFL injury was detected in 78.7% of patients, posterior malleolus bone oedema in 60.2% and posterior malleolus fracture in 15.7%. The proportion of patients with injury to the PITFL in intermediate patients was 59.4% and 29.2% in chronic patients which was significantly lower than in acute patients (p<0.001). Twenty eight patients with posterior malleolus bone oedema had an apparently normal PITFL. The proportion of patients with posterior malleolus bone oedema or fracture were not significantly different between groups. Conclusion: The most important finding of the current study is that in acute high ankle sprains with syndesmosis instability, MRI detected a posterior syndesmosis injury in 93.5% of patients. Posterior malleolus bone oedema appears to be a marker of an unstable syndesmosis injury, regardless of time from injury to the MRI scan. The ability of MRI to detect a posterior syndesmosis injury reduces significantly if delayed more than 12 weeks. If suspicious of a high ankle sprain, we advocate early MRI assessment to help determine stable versus unstable injuries, as the ability of MRI to detect posterior injuries reduces over time.

scholarly journals Performance on a Single-Legged Drop-Jump Landing Test Is Related to Increased Risk of Lateral Ankle Sprains Among Male Elite Soccer Players: A 3-Year Prospective Cohort Study

2018 ◽  
Vol 46 (14) ◽  
pp. 3454-3462 ◽  
Author(s):  
Duncan P. Fransz ◽  
Arnold Huurnink ◽  
Idsart Kingma ◽  
Vosse A. de Boode ◽  
Ide C. Heyligers ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ankle Sprain ◽  
Reaction Force ◽  
Soccer Players ◽  
Ankle Sprains ◽  
Drop Jump ◽  
Lateral Ankle ◽  
Jump Landing ◽  
Increased Risk

Background: Soccer has a high injury rate, with lateral ankle sprains being a common injury. Therefore, an approach to prevent or at least reduce the occurrence is warranted. Injury prevention can be improved by identifying specific risk factors and individuals at risk. Purpose: To assess drop-jump landing performance as a potential predictor of lateral ankle sprain within 3-year follow-up. Study Design: Case-control study; Level of evidence, 3. Methods: Single-legged drop-jump landing tests were performed by 190 elite soccer players. Based on ground-reaction forces, 6 outcome measures were calculated that aim to reflect the impact and stabilization phase. Lateral ankle sprains were registered during up to 3 years of follow-up. Following a z score correction for age, a multivariate regression analysis was performed. Results: During follow-up, 45 players (23.7%) suffered a primary lateral ankle sprain. Of those, 34 were regarded as severe (absence >7 days). Performance was related to increased risk of ankle sprain ( P = .005 for all sprains and P = .001 for severe sprains). Low mediolateral stability for the first 0.4 seconds after landing (a larger value indicates more force exerted in the mediolateral direction, resulting in rapid lateral stabilization) and high horizontal ground-reaction force between 3.0 and 5.0 seconds (a smaller value indicates less sway in the stabilization phase) were identified as risk factors. A player that scored 2 SD below average for both risk factors had a 4.4-times-higher chance of sustaining an ankle sprain than a player who scored average. Conclusion: The current study showed that following a single-legged drop-jump landing, mediolateral force over 0 to 0.4 seconds and/or mean resultant horizontal ground-reaction force over 3 to 5 seconds has predictive value with regard to the occurrence of an ankle sprain among male elite soccer players within 3 years.

scholarly journals Doctor YouTube: A Quality Analysis Of Medical Information Videos On The Video Platform YouTube On Ankle Sprain

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0045
Author(s):  
Michael Zyskowski ◽  
Sebastian Pesch ◽  
Frederik Greve ◽  
Francesca von Matthey ◽  
Markus Wurm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Examination ◽  
Ankle Sprain ◽  
Medical Information ◽  
Ankle Injuries ◽  
Quality Analysis ◽  
Search Term ◽  
Ankle Sprains ◽  
Ankle Pain ◽  
Video Tutorials

Category: Ankle, Sports, Trauma Introduction/Purpose: The video portal YouTube has evolved from pure entertainment to professional and semi-professional video tutorials and medical video channels in the recent past. As a result, YouTube today is a source of information that is widely used by patients and relatives. Ankle sprains are one of the most common musculoskeletal injuries, this study was designed to analyze the quality of informational videos available on YouTube and to identify potential hazards as well as content errors. Methods: In July 2016, YouTube was searched for the terms “ankle sprain”, “high ankle sprain”, “ankle pain” and “ankle pain distortion”. The analysis was limited to the first 5 result pages for each search term. Only English and German videos were included. The videos were found by 2 independent evaluators (MZ, SP) using a multi-dimensional score checklist for the sections anatomy, risk factors and symptoms (max 8 pts), biomechanics (max 3 pts), imaging (max 2 pts), clinical examination (max 6 pts), treatment (max 5 pts), rehabilitation measures (max 2 pts) and prevention (max 2 pts) with a maximum scores per contribution of 31 pts evaluated. Results: The mean score of the video quality was 11.5 ± 4.5 pts. Distribution of points by subgroup: anatomy, risk factors and symptoms 3.7 ± 1.4, biomechanics 1,8 ± 1.2, imaging 0.9 ± 0.8, clinical examination 1.3 ± 1.2, treatment 2 ± 1.3, rehabilitation 1.1 ± 0.9, prevention 0.6 ± 1. No evaluated contribution achieved “very good” Quality Assessment Score of 25-31 pts, one video was rated ”good” with 21-26 pts, 2 videos were “satisfactory” (20-16 pts), 14 videos ”sufficient” (15-10 pts.). 7 videos were rated as “insufficient” (9-4 pts). One clip (2.5 pts) was rated as a promotional video. A slight correlation between views by videos and score (r = 0.11) and a small correlation between the total score and Likes occured (r = 0.15). Conclusion: Patients watching online video tutorials on ankle injuries are seeking valid information. YouTube gives an extensive video footage of low quality. The defective and incorrect information analyzed by us must be corrected by medical advice. Furthermore, the presented investigation shows an average to bad quality so that the introduction of a seal of approval by the AOFAS for digital content, based on an evidence-based quality control should be discussed in the future.

scholarly journals Osteomyelitis of the mandible with pseudotumoral manifestation

2016 ◽  
Vol 11 (2) ◽  
pp. 200-203
Author(s):  
A. ZAMFIR-CHIRU-ANTON ◽  
◽  
A.E. STANCIU ◽  
D.C. GHEORGHE ◽  
◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Clinical Examination ◽  
Correct Diagnosis ◽  
Cellular Infiltration ◽  
Osteolytic Lesions ◽  
Case Presentation ◽  
Infectious Origin ◽  
Uncommon Disease ◽  
Diagnosis Therapy

Osteomyelitis of the mandible is an uncommon disease, sometimes with severe invalidating symptoms. Some cases can present as tumors of the jaw and are possibly seen in ENT practice. Objective. To present the differential diagnosis of mandibular swellings of inflammatory origin. Material, method. Case presentation of a 9y child admitted and biopsied in the ENT department. Results. Histologic examination showed focal areas of osteolytic lesions along with moderate inflammatory cellular infiltration, all within newly formed bone. Under NSAI drugs, the symptoms were alleviated, the patient remaining under close follow-up. Conclusion. Osteomyelitis of the mandible is not always of infectious origin. The clinical examination, the imagistics and biopsy are key elements to correct diagnosis. Therapy is still under evaluation for noninfectious osteomyelitis.

scholarly journals Clinical Examination Results in Individuals With Functional Ankle Instability and Ankle-Sprain Copers

2013 ◽  
Vol 48 (5) ◽  
pp. 581-589 ◽  
Author(s):  
Cynthia J. Wright ◽  
Brent L. Arnold ◽  
Scott E. Ross ◽  
Jessica Ketchum ◽  
Jeffrey Ericksen ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Clinical Examination ◽  
Ankle Sprain ◽  
Daily Living ◽  
Ankle Instability ◽  
Ankle Sprains ◽  
Foot And Ankle ◽  
Functional Ankle Instability ◽  
History Of ◽  
Ability Measure

Context: Why some individuals with ankle sprains develop functional ankle instability and others do not (ie, copers) is unknown. Current understanding of the clinical profile of copers is limited. Objective: To contrast individuals with functional ankle instability (FAI), copers, and uninjured individuals on both self-reported variables and clinical examination findings. Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Participants consisted of 23 individuals with a history of 1 or more ankle sprains and at least 2 episodes of giving way in the past year (FAI: Cumberland Ankle Instability Tool [CAIT] score = 20.52 ± 2.94, episodes of giving way = 5.8 ± 8.4 per month), 23 individuals with a history of a single ankle sprain and no subsequent episodes of instability (copers: CAIT score = 27.74 ± 1.69), and 23 individuals with no history of ankle sprain and no instability (uninjured: CAIT score = 28.78 ± 1.78). Intervention(s): Self-reported disability was recorded using the CAIT and Foot and Ankle Ability Measure for Activities of Daily Living and for Sports. On clinical examination, ligamentous laxity and tenderness, range of motion (ROM), and pain at end ROM were recorded. Main Outcome Measure(s): Questionnaire scores for the CAIT, Foot and Ankle Ability Measure for Activities of Daily Living and for Sports, ankle inversion and anterior drawer laxity scores, pain with palpation of the lateral ligaments, ankle ROM, and pain at end ROM. Results: Individuals with FAI had greater self-reported disability for all measures (P &lt; .05). On clinical examination, individuals with FAI were more likely to have greater talar tilt laxity, pain with inversion, and limited sagittal-plane ROM than copers (P &lt; .05). Conclusions: Differences in both self-reported disability and clinical examination variables distinguished individuals with FAI from copers at least 1 year after injury. Whether the deficits could be detected immediately postinjury to prospectively identify potential copers is unknown.

Ligaclip for Preauricular Skin Tags in the Newborn

2020 ◽  
Author(s):  
Fabrizio Shonauer ◽  
Antonio Guastafierro ◽  
Elisabetta Grasso ◽  
Sara Izzo ◽  
Giovanni Francesco Nicoletti ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Retrospective Study ◽  
Hair Follicle ◽  
Clinical Examination ◽  
Benign Lesions ◽  
Pilosebaceous Unit ◽  
Skin Tag ◽  
Careful Clinical Examination ◽  
Skin Tags

Abstract Introduction Skin tags are benign lesions, that often represent only an aesthetic problem; if subjected to trauma, they can occasionally bleed with possible infection and pain. When they occur in the preauricular region, attention should be paid to the diagnosis and approach; in fact, controversy exists in the differential diagnosis between hair follicle nevi, accessory tragus, and skin tag. Misdiagnosis and failure of treatment can lead to serious consequences, such as chondritis. Materials and Methods In our retrospective study, we evaluated 19 newborns affected by single, unilateral skin tag in the preauricular region. Each patient underwent a careful clinical examination; lesions without a pilosebaceous unit and with a thin, soft pedicle were treated in the nursery with Ligaclip (Johnson & Johnson). Results Skin tag falls between day 7 and 10. We had no cases of edema, cellulitis, clip loss, or bleeding. Scarring results were extremely satisfactory at 3-month follow-up. Conclusion We believe that after a careful clinical examination, cases of skin tags in the preauricular area can be selected and treated with Ligaclip. This procedure can be considered rapid, safe, economical, and simple in the newborn patients.

scholarly journals PEUTZ JEGHERS SYNDROME - DIAGNOSIS AT THE TIME OF OCLUZIVE COMPLICATION

2018 ◽  
Vol 1 (1) ◽  
pp. 3-4
Author(s):  
Daniel Ion ◽  
Dan Nicolae Păduraru ◽  
Alexandra Bolocan
Keyword(s):  
Clinical Examination ◽  
Autosomal Dominant ◽  
Histopathological Examination ◽  
Tumor Formation ◽  
Increased Risk ◽  
Low Incidence ◽  
Probable Origin ◽  
Peutz Jeghers Syndrome ◽  
Dominant Condition

Puetz Jeghers syndrome is a rare, genetically conditioned, autosomal dominant condition characterized by gastrointestinal haemarthromatic polyps, cutaneous mucosal pigmentation and increased risk of neoplasia. Frequent diagnosis is due to melanin stains, evident in the first years of life, and which fades with age. We present the case of a 24-year-old patient who has presented with the diagnosis of intestinal occlusion. An earlier CT scan describes a tumor formation that occupies the entire pelvis and the lower abdominal floor with a probable origin of digestive tract. The clinical examination at admission revealed hyperpigmentation in the lips, oral and tegumentary mucosa, and the suspicion of the Puetz Jeghers syndrome was raised. Intraoperatively there are found three tumors on the jejunum, the distal one causing an invasion of about 1.5 m long, with necrosis of the respective segment for which enterectomy and entero-entero anastomosis was performed. The histopathological examination performed from the surgically resected piece confirms the diagnosis. The teachings based on this case take into account both the necessity of a correct and fully performed clinical examination, especially the need for the patient's adherence to a follow-up management of the evolution of the disease. Rare diseases represent a challenge for the practitioner through the low incidence, but the application of therapeutic management to these patients should be guided by research conducted in specialized centers.

scholarly journals Ankle Sprain Has Higher Occurrence During the Latter Parts of Matches: Systematic Review With Meta-Analysis

2019 ◽  
Vol 28 (4) ◽  
pp. 373-380 ◽  
Author(s):  
Marcos de Noronha ◽  
Eleisha K. Lay ◽  
Madelyn R. Mcphee ◽  
George Mnatzaganian ◽  
Guilherme S. Nunes
Keyword(s):  
Ankle Sprain ◽  
Assessment Tool ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
American Football ◽  
Ankle Sprains ◽  
Quality Assessment Tool ◽  
Quantitative Studies ◽  
Meta Analyses

Context:Ankle sprains are common injuries in sports, but it is unclear whether they are more likely to occur in a specific period of a sporting game.Objective:To systematically review the literature investigating when in a match ankle sprains most likely occurred.Evidence Acquisition:The databases CINAHL, EMBASE, MEDLINE, and SPORTDiscus were searched up to August 2016, with no restriction of date or language. The search targeted studies that presented data on the time of occurrence of ankle sprains during sports matches. Data from included studies were analyzed as a percentage of ankle sprain occurrence by halftime and by quarters. Meta-analyses were run using a random effects model. The quality assessment tool for quantitative studies was used to assess the article’s quality.Evidence Synthesis:The searches identified 1142 studies, and 8 were included in this review. A total of 500 ankle sprains were reported during follow-up time, which ranged from 1 to 15 years, in 5 different sports (soccer, rugby, futsal, American football, and Gaelic football). The meta-analyses, including all 8 studies, showed that the proportion of ankle sprains during the first half (0.44; 95% confidence interval [CI], 0.38–0.50) was smaller than the second half (0.56; 95% CI, 0.50–0.62). For the analyses by quarters, the proportion of ankle sprains in the first quarter (0.14; 95% CI, 0.09–0.19) was considerably smaller than the second (0.28; 95% CI, 0.24–0.32), third (0.25; 95% CI, 0.17–0.34), and fourth (0.29; 95% CI, 0.22–0.36) quarters.Conclusion:The results of this review indicate that ankle sprains are more likely to occur later in the game during the second half or during the latter minutes of the first half.

scholarly journals Superficial peroneal nerve entrapment in ankle sprain in childhood and adolescence

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Francesco Falciglia ◽  
Luca Basiglini ◽  
Angelo G. Aulisa ◽  
Renato M. Toniolo
Keyword(s):  
Ankle Sprain ◽  
Peroneal Nerve ◽  
First Episode ◽  
Childhood And Adolescence ◽  
Ankle Sprains ◽  
Superficial Peroneal Nerve ◽  
Residual Symptoms ◽  
Persistent Symptoms ◽  
Perineural Fibrosis

AbstractTraumatic injuries of the ankle are the most common injuries in sports. Up to 40% of patients who have undergone inversion ankle sprain report residual symptoms. The primary purpose of the study is to evaluate the incidence of SPN entrapment as consequence of acute severe inversion ankle sprain in children and adolescents; the secondary is to report the diagnostic pathway and the results after surgical treatment. From 2000 to 2015 were reviewed to summarize patients under the age of 15 years treated for a first episode of severe inversion ankle sprain. Cases with persistent symptoms (more than 3 months) indicative for SPN neuropathy were then identified. Instrumental investigations were recovered and a pre-operative assessment of pain (VAS) was recorded. Patients were evaluated at minimum of 1-year post-operative follow-up. 981 acute ankle sprains have been evaluated. 122 were considered severe according to van Dijk criteria. 5 patients were considered affected by neuropathy of the SPN. All patients underwent surgery consisting in neurolysis and capsular retention and ligament reconstruction. At 25 months of follow-up AOFAS moved from 57.6 to 98.6. The study highlights a previously unreported condition of perineural fibrosis of the superficial peroneal nerve at the level of the ankle following first acute severe inversion ankle sprain in children.

Tumor Diagnosis

1982 ◽  
Vol 40 ◽  
pp. 262-265
Author(s):  
Bruce Mackay
Keyword(s):  
Electron Microscopy ◽  
Transmission Electron Microscopy ◽  
Differential Diagnosis ◽  
Light Microscopy ◽  
Clinical Examination ◽  
Ultrastructural Study ◽  
Diagnostic Procedures ◽  
Specific Diagnosis ◽  
Transmission Electron ◽  
Microscopic Diagnosis

The broadest application of transmission electron microscopy (EM) in diagnostic medicine is the identification of tumors that cannot be classified by routine light microscopy. EM is useful in the evaluation of approximately 10% of human neoplasms, but the extent of its contribution varies considerably. It may provide a specific diagnosis that can not be reached by other means, but in contrast, the information obtained from ultrastructural study of some 10% of tumors does not significantly add to that available from light microscopy. Most cases fall somewhere between these two extremes: EM may correct a light microscopic diagnosis, or serve to narrow a differential diagnosis by excluding some of the possibilities considered by light microscopy. It is particularly important to correlate the EM findings with data from light microscopy, clinical examination, and other diagnostic procedures.

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