Classification and treatment of ankle fractures

Ankle fractures

Although ankle injuries are common, it is imperative for the treating physician to be able to identify the mechanism of injury and accurately restore the normal anatomy of the ankle joint. Attention must be given to restoring the normal alignment and length of the fibula because of its dominant role in controlling talar stability. The medial ankle must not be overlooked, with the role of the deltoid taken into consideration. With a thorough understanding of the anatomy, biomechanics, mechanism of injury, and fixation techniques, repair of the damaged ankle joint can lead to rewarding outcomes for the patient and physician.

Evaluation and treatment of chemonucleolysis failures

Fifty patients underwent chemonucleolysis for the treatment of lumbar disk herniations unresponsive to conservative therapy. In patients treated with chymopapain, unrelieved sciatica was the most common cause of clinical treatment failure. Eight patients (16%) experienced no relief or only a transient reduction in their radicular symptoms following chymopapain injection. All eight patients were clinically reevaluated and underwent repeat neuroradiographic studies. Computed axial tomography and lumbar myelography demonstrated persistent nerve root compromise at the level of the injected disk space. Open diskectomy was performed in all eight cases. Postoperatively, seven patients noted complete resolution of their radicular symptoms; one patient had intermittent low back and leg pain following surgery.

Current practice with chymopapain for treatment of herniated nucleus pulposus

Chemonucleolysis is found to compare favorably with laminectomy (71% good to excellent results versus 63% good to excellent) in the treatment of herniated nucleus pulposus. From a base of over 400 chemonucleolysis cases, recommendations for equipment and patient selection are developed. Disc space narrowing did not correlate with the end results.

A case study: the need for evaluation and reevaluation of acute ankle injury

Although physical therapists are not trained to "diagnose, " it is essential that they possess competent evaluation skills and the ability to form accurate impressions which are then treated accordingly. This is especially true when the physical therapist is the first line of professional intervention in treating injury. Emphasis of this case report is not on new or unusual evaluation-treatment techniques. Rather, the key to efficient care of the athlete lies in the perseverance of the health care professional in reevaluation, appropriate precautions, and adequate follow-up. J Orthop Sports Phys Ther 1982;4(1):44-46.

Fractures through the distal weight-bearing surface of the tibia

Fractures of the distal tibial plafond have been associated with an usually high incidence of morbidity and both early and late complications. Fractures through the distal tibial plafond can be divided into three basic groups: (1) distal tibial compression fractures; (2) external rotatory trimalleolar fractures with large posterior fragments; and (3) spiral extension fractures. Loss of length and alignment at the ankle joints, with concomitant loss of congruity of the articular surface, requires innovative intervention to prevent disability. The prognosis for these fractures depends not only on the amount of articular involvement of the ankle joint, but also on the accuracy of the reduction and the details of postoperative care.