BACKGROUND Pigmented villonodular synovitis(PVNS)is an uncommon disease that usually occurs in large joints,and involvement of the subtalar joint is rare.The lack of comprehensive knowledge of subtalar joint PVNS coul...BACKGROUND Pigmented villonodular synovitis(PVNS)is an uncommon disease that usually occurs in large joints,and involvement of the subtalar joint is rare.The lack of comprehensive knowledge of subtalar joint PVNS could lead to misdiagnosis.CASE SUMMARY We present a 64-year-old woman who,at her first visit,complained of discomfort in the right ankle when she walked.Based on the physical signs and X-ray report,the physician failed to make the suspected diagnosis of PVNS.Eighteen months later,the patient returned with a complaint of a mass in her right lateral malleolus with intermittent blunt pain.The X-ray presented an osteophyte formation and soft tissue calcification at the margin of the subtalar joint.The laboratory tests were normal,whereas magnetic resonance imaging(MRI)showed a low-intensity area on both T1-and T2-weighted images.A suspected diagnosis of PVNS was made and later confirmed by postoperative pathology.Subsequently,the patient received radiotherapy with 32 Gy in 16 fractions.At 6 mo postoperatively,the patient only complained of discomfort after walking three blocks.The American Orthopedic Foot and Ankle Society Ankle-Hindfoot score was 97.CONCLUSION MRI is necessary for the diagnosis of PVNS.Early soft tissue calcification and painless joint swelling should be of concern.展开更多
Subtalar dislocation is defined as a separation of the talocalcaneal and talonavicular articulations,commonly caused by high-energy mechanisms,which include falls from height,motor vehicle crashes,and twisting leg inj...Subtalar dislocation is defined as a separation of the talocalcaneal and talonavicular articulations,commonly caused by high-energy mechanisms,which include falls from height,motor vehicle crashes,and twisting leg injuries.The dislocations are divided into medial,lateral,anterior,and posterior types on the basis of the direction in which the distal part of the foot has shifted in relation to the talus.The most common type is medial dislocation resulted from inversion injury.Subtalar dislocation may accompany with other fractures.Physical examination must be performed carefully to assess for neurovascular compromise.Most of the subtalar dislocations can be treated with closed reduction under sedation.If this is not possible,open reduction without further delay should be conducted.After primary treatment,X-ray and computed tomography scan should be performed to evaluate the alignment and the fractures.We report a 37-year-old male patient sustained a subtalar dislocation without any bony injury when he was playing football.The patient was successfully treated by closed reduction,and a good alignment was observed at the last follow-up.The pathogenesis and treatment method of this case were analyzed,and the related literature were reviewed,which provided a reference for future clinical treatment.展开更多
Background Subtalar joint （STJ） neutral position is the position typically used by clinicians to obtain a cast representation of a patient＇s foot before fabrication of biomechanical functional orthosis. But no meth...Background Subtalar joint （STJ） neutral position is the position typically used by clinicians to obtain a cast representation of a patient＇s foot before fabrication of biomechanical functional orthosis. But no method for measuring STJ neutral position has been proven accurate and reproducible by different testers. This study was conducted to investigate the STJ neutral position in normal feet in cadavers. Methods Twelve fresh-frozen specimens of amputated lower legs were used. Pressure-sensitive films were inserted into the anterior and posterior articulation of STJ. The contact areas for various foot positions and under axial loads of 600 N were determined based on the gray level of the digitized film. The STJ neutral positions were determined as the ankle-foot position where the maximum contact area was achieved, because the neutral position of a joint was defined as the position where the concave and convex surfaces were completely congruous. Results In ankle-foot neutral position, the contact area of STJ was （2.79±0.24） cm^2. In the range of motion of adduction-abduction （ADD-ABD）, the maximum contact area was （3.00±0.26） cm^2 when the foot was positioned 10° of ABD （F=-221.361, P 〈0.05）. In the range of motion of dorsiflexion-plantarflexion （DF-PF）, the maximum contact area was （3.61±0.25） cm^2 when the foot was positioned 20° of DF （F=-121.067, P 〈0.05）. In the range of motion of inversion-eversion （INV-EV）, the maximum contact area was （3.14±0.26） cm^2 when the foot was positioned 10° of EV （F=-256.252, P〈0.05）. Conclusions Joints, such as STJ, therefore, are not necessarily in neutral position when the ankle-foot is placed in the traditional concept of neutral position. The results demonstrate that the most approximate STJ neutral position was in the foot Dosition of 10° of abduction, 20° of dorsiflexion and 10° of eversion.展开更多
Accurate knowledge of the kinematics of the in vivo Ankle Joint Complex(AJC)is critical for understanding the biomechanical function of the foot and assessing postoperative rehabilitation of ankle disorders,as well as...Accurate knowledge of the kinematics of the in vivo Ankle Joint Complex(AJC)is critical for understanding the biomechanical function of the foot and assessing postoperative rehabilitation of ankle disorders,as well as an essential guide to the design of ankle–foot assistant devices.However,detailed analysis of the continuous 3D motion of the tibiotalar and subtalar joints during normal walking throughout the stance phase is still considered to be lacking.In this study,dynamic radiographs of the hindfoot were acquired from eight subjects during normal walking.Natural motions with six Degrees of Freedom(DOF)and the coupled patterns of the two joints were analyzed.It was found that the movements of the two joints were mostly in opposite directions(including rotation and translation),mainly in the early and late stages.There were significant differences in the Range of Motion(ROM)in Dorsiflexion/Plantarflexion(D/P),Inversion/Eversion(In/Ev),and Anterior–Posterior(AP)and Medial–Lateral(ML)translation of the tibiotalar and subtalar joints(p<0.05).Plantarflexion of the tibiotalar joint was coupled with eversion and posterior translation of the subtalar joint during the impact phase(R^(2)=0.87 and 0.86,respectively),and plantarflexion of the tibiotalar joint was coupled with inversion and anterior translation of the subtalar joint during the push-off phase(R^(2)=0.93 and 0.75,respectively).This coordinated coupled motion of the two joints may be a manifestation of the AJC to move flexibly while bearing weight and still have stability.展开更多
Subtalar dislocation is described as the simultaneous dislocation of the talo-calcaneal and talo-navicular joints without any tibio-talar or talar neck associated fractures. This injury is rare, and represents 1% of d...Subtalar dislocation is described as the simultaneous dislocation of the talo-calcaneal and talo-navicular joints without any tibio-talar or talar neck associated fractures. This injury is rare, and represents 1% of dislocations. We report the case of 28-year-old male patient, without any medical history, who had been involved in a sport accident causing a rare closed external subtalar dislocation without any bone fracture. An open reduction was indicated after failure of closed reduction and the X-ray control showed good joint congruence;the fixation was maintained for 6 weeks and then the rehabilitation was started. The evaluation was favorable, and we noted good functional results after a decline of 12 months.展开更多
A case of complicated lateral subtalar dislocation is presented and the literature concerning this injury is reviewed. Subtalar joint dislocations are rare and often the result of a high-energy trauma. Complications i...A case of complicated lateral subtalar dislocation is presented and the literature concerning this injury is reviewed. Subtalar joint dislocations are rare and often the result of a high-energy trauma. Complications include avascular necrosis of the talus, infection, posttraumatic osteoarthritis requiring arthrodesis and chronic subtalar instability. Negative prognostic factors include lateral and complicated dislocations, total talar extrusions, and associated fractures. A literature search was performed to identify studies describing outcome after lateral subtalar joint dislocation. Eight studies including fifty patients could be included, thirty out of 50 patients suffered a complicated injury. Mean follow-up was fifty-five months. Ankle function was reported as good in all patients with closed lateral subtalar dislocation.Thirteen out of thirty patients with complicated lateral subtalar joint dislocation developed a complication.Avascular necrosis was present in nine patients with complicated injury. Four patients with complicated lateral subtalar dislocation suffered deep infection requiring treatment with antibiotics. In case of uncomplicated lateral subtalar joint dislocation, excellent functional outcome after closed reduction and immobilization can be expected. In case of complicated lateral subtalar joint dislocation immediate reduction, wound debridement and if necessary(external) stabilisation are critical. Up to fifty percent of patients suffering complicated injury are at risk of developing complications such as avascular talar necrosis and infection.展开更多
Fracture of the lateral process of the talus(FLPT)is uncommon in clinical practice and can be easily missed or misdiagnosed.In recent years,as researchers from all over the world have further deepened their research o...Fracture of the lateral process of the talus(FLPT)is uncommon in clinical practice and can be easily missed or misdiagnosed.In recent years,as researchers from all over the world have further deepened their research on FLPT,there has been a breakthrough in the classification,and the methods and principles of clinical management have changed accordingly;however,there is still no standardized guideline for the diagnosis and management of FLPT,and there have been few relevant literature review articles related to this kind of fracture in the past at least 5 years.In this article,we review the clinical classification,classification-based therapeutic recommendations,and prognosis of FLPT,with the aim of providing a reference for the clinical diagnosis and management of this infrequent fracture.展开更多
Fractures of the lateral process of the talus(FLPT)are uncommon fractures that represent a clinical challenge.Traditional radiological classification systems rely predominantly on radiographic findings.However,due to ...Fractures of the lateral process of the talus(FLPT)are uncommon fractures that represent a clinical challenge.Traditional radiological classification systems rely predominantly on radiographic findings.However,due to the high rate of FLPT misdiagnosis and the limited accuracy in evaluating concomitant talar injuries through plain radiographs,novel imaging classification systems have been developed that aim to enhance the diagnosis of concomitant talar injuries,thereby optimizing patient management and reducing the incidence of long-term complications.展开更多
文摘BACKGROUND Pigmented villonodular synovitis(PVNS)is an uncommon disease that usually occurs in large joints,and involvement of the subtalar joint is rare.The lack of comprehensive knowledge of subtalar joint PVNS could lead to misdiagnosis.CASE SUMMARY We present a 64-year-old woman who,at her first visit,complained of discomfort in the right ankle when she walked.Based on the physical signs and X-ray report,the physician failed to make the suspected diagnosis of PVNS.Eighteen months later,the patient returned with a complaint of a mass in her right lateral malleolus with intermittent blunt pain.The X-ray presented an osteophyte formation and soft tissue calcification at the margin of the subtalar joint.The laboratory tests were normal,whereas magnetic resonance imaging(MRI)showed a low-intensity area on both T1-and T2-weighted images.A suspected diagnosis of PVNS was made and later confirmed by postoperative pathology.Subsequently,the patient received radiotherapy with 32 Gy in 16 fractions.At 6 mo postoperatively,the patient only complained of discomfort after walking three blocks.The American Orthopedic Foot and Ankle Society Ankle-Hindfoot score was 97.CONCLUSION MRI is necessary for the diagnosis of PVNS.Early soft tissue calcification and painless joint swelling should be of concern.
文摘Subtalar dislocation is defined as a separation of the talocalcaneal and talonavicular articulations,commonly caused by high-energy mechanisms,which include falls from height,motor vehicle crashes,and twisting leg injuries.The dislocations are divided into medial,lateral,anterior,and posterior types on the basis of the direction in which the distal part of the foot has shifted in relation to the talus.The most common type is medial dislocation resulted from inversion injury.Subtalar dislocation may accompany with other fractures.Physical examination must be performed carefully to assess for neurovascular compromise.Most of the subtalar dislocations can be treated with closed reduction under sedation.If this is not possible,open reduction without further delay should be conducted.After primary treatment,X-ray and computed tomography scan should be performed to evaluate the alignment and the fractures.We report a 37-year-old male patient sustained a subtalar dislocation without any bony injury when he was playing football.The patient was successfully treated by closed reduction,and a good alignment was observed at the last follow-up.The pathogenesis and treatment method of this case were analyzed,and the related literature were reviewed,which provided a reference for future clinical treatment.
文摘Background Subtalar joint （STJ） neutral position is the position typically used by clinicians to obtain a cast representation of a patient＇s foot before fabrication of biomechanical functional orthosis. But no method for measuring STJ neutral position has been proven accurate and reproducible by different testers. This study was conducted to investigate the STJ neutral position in normal feet in cadavers. Methods Twelve fresh-frozen specimens of amputated lower legs were used. Pressure-sensitive films were inserted into the anterior and posterior articulation of STJ. The contact areas for various foot positions and under axial loads of 600 N were determined based on the gray level of the digitized film. The STJ neutral positions were determined as the ankle-foot position where the maximum contact area was achieved, because the neutral position of a joint was defined as the position where the concave and convex surfaces were completely congruous. Results In ankle-foot neutral position, the contact area of STJ was （2.79±0.24） cm^2. In the range of motion of adduction-abduction （ADD-ABD）, the maximum contact area was （3.00±0.26） cm^2 when the foot was positioned 10° of ABD （F=-221.361, P 〈0.05）. In the range of motion of dorsiflexion-plantarflexion （DF-PF）, the maximum contact area was （3.61±0.25） cm^2 when the foot was positioned 20° of DF （F=-121.067, P 〈0.05）. In the range of motion of inversion-eversion （INV-EV）, the maximum contact area was （3.14±0.26） cm^2 when the foot was positioned 10° of EV （F=-256.252, P〈0.05）. Conclusions Joints, such as STJ, therefore, are not necessarily in neutral position when the ankle-foot is placed in the traditional concept of neutral position. The results demonstrate that the most approximate STJ neutral position was in the foot Dosition of 10° of abduction, 20° of dorsiflexion and 10° of eversion.
基金supported by the National Natural Science Foundation of China(52175270,91848204)the Project of Scientific and Technological Development Plan of Jilin Province(20220508130RC).
文摘Accurate knowledge of the kinematics of the in vivo Ankle Joint Complex(AJC)is critical for understanding the biomechanical function of the foot and assessing postoperative rehabilitation of ankle disorders,as well as an essential guide to the design of ankle–foot assistant devices.However,detailed analysis of the continuous 3D motion of the tibiotalar and subtalar joints during normal walking throughout the stance phase is still considered to be lacking.In this study,dynamic radiographs of the hindfoot were acquired from eight subjects during normal walking.Natural motions with six Degrees of Freedom(DOF)and the coupled patterns of the two joints were analyzed.It was found that the movements of the two joints were mostly in opposite directions(including rotation and translation),mainly in the early and late stages.There were significant differences in the Range of Motion(ROM)in Dorsiflexion/Plantarflexion(D/P),Inversion/Eversion(In/Ev),and Anterior–Posterior(AP)and Medial–Lateral(ML)translation of the tibiotalar and subtalar joints(p<0.05).Plantarflexion of the tibiotalar joint was coupled with eversion and posterior translation of the subtalar joint during the impact phase(R^(2)=0.87 and 0.86,respectively),and plantarflexion of the tibiotalar joint was coupled with inversion and anterior translation of the subtalar joint during the push-off phase(R^(2)=0.93 and 0.75,respectively).This coordinated coupled motion of the two joints may be a manifestation of the AJC to move flexibly while bearing weight and still have stability.
文摘Subtalar dislocation is described as the simultaneous dislocation of the talo-calcaneal and talo-navicular joints without any tibio-talar or talar neck associated fractures. This injury is rare, and represents 1% of dislocations. We report the case of 28-year-old male patient, without any medical history, who had been involved in a sport accident causing a rare closed external subtalar dislocation without any bone fracture. An open reduction was indicated after failure of closed reduction and the X-ray control showed good joint congruence;the fixation was maintained for 6 weeks and then the rehabilitation was started. The evaluation was favorable, and we noted good functional results after a decline of 12 months.
文摘A case of complicated lateral subtalar dislocation is presented and the literature concerning this injury is reviewed. Subtalar joint dislocations are rare and often the result of a high-energy trauma. Complications include avascular necrosis of the talus, infection, posttraumatic osteoarthritis requiring arthrodesis and chronic subtalar instability. Negative prognostic factors include lateral and complicated dislocations, total talar extrusions, and associated fractures. A literature search was performed to identify studies describing outcome after lateral subtalar joint dislocation. Eight studies including fifty patients could be included, thirty out of 50 patients suffered a complicated injury. Mean follow-up was fifty-five months. Ankle function was reported as good in all patients with closed lateral subtalar dislocation.Thirteen out of thirty patients with complicated lateral subtalar joint dislocation developed a complication.Avascular necrosis was present in nine patients with complicated injury. Four patients with complicated lateral subtalar dislocation suffered deep infection requiring treatment with antibiotics. In case of uncomplicated lateral subtalar joint dislocation, excellent functional outcome after closed reduction and immobilization can be expected. In case of complicated lateral subtalar joint dislocation immediate reduction, wound debridement and if necessary(external) stabilisation are critical. Up to fifty percent of patients suffering complicated injury are at risk of developing complications such as avascular talar necrosis and infection.
基金Supported by The China Scholarship Council,No.202308420035.
文摘Fracture of the lateral process of the talus(FLPT)is uncommon in clinical practice and can be easily missed or misdiagnosed.In recent years,as researchers from all over the world have further deepened their research on FLPT,there has been a breakthrough in the classification,and the methods and principles of clinical management have changed accordingly;however,there is still no standardized guideline for the diagnosis and management of FLPT,and there have been few relevant literature review articles related to this kind of fracture in the past at least 5 years.In this article,we review the clinical classification,classification-based therapeutic recommendations,and prognosis of FLPT,with the aim of providing a reference for the clinical diagnosis and management of this infrequent fracture.
文摘Fractures of the lateral process of the talus(FLPT)are uncommon fractures that represent a clinical challenge.Traditional radiological classification systems rely predominantly on radiographic findings.However,due to the high rate of FLPT misdiagnosis and the limited accuracy in evaluating concomitant talar injuries through plain radiographs,novel imaging classification systems have been developed that aim to enhance the diagnosis of concomitant talar injuries,thereby optimizing patient management and reducing the incidence of long-term complications.
