Disruption of the distal tibiofibular syndesmosis is frequently accompanied by rotational ankle fracture such as pronation-external rotation and rarely occurs without ankle fracture.In such injury,not only inadequatel...Disruption of the distal tibiofibular syndesmosis is frequently accompanied by rotational ankle fracture such as pronation-external rotation and rarely occurs without ankle fracture.In such injury,not only inadequately treated or misdiagnosed cases,but also correctly diagnosed cases can possibly result in a chronic pattern which is more troublesome to treat than an acute pattern.This paper reviews anatomical and biomechanical characteristics of the distal tibiofibular joint,the mechanism of chronic disruption of the distal tibiofibular syndesmosis,radiological and arthroscopic diagnosis,and surgical treatment.展开更多
Although ganglion cysts occur frequently, their presence in the lower extremities is rare and they seldom cause peripheral nerve compression. There are enumerable case reports of intraneural ganglion involvement with ...Although ganglion cysts occur frequently, their presence in the lower extremities is rare and they seldom cause peripheral nerve compression. There are enumerable case reports of intraneural ganglion involvement with the common peroneal nerve and its branches, the sural nerve, and the posterior tibial nerve but extraneural ganglion sciatic and common peroneal nerve palsy cases are quite rare. Our case, a 26 years old female patient presented with right leg tingling and radiating pain followed up gradually with progressive right sided foot drop. MRI diagnosed the lesion as a ganglion cyst and the EMG/NCV confirmed the level of compression at the right fibular head. The patient was electively operated with standard lateral approach and the ganglion cyst engulfing the common peroneal nerve was excised. The cyst was traced to the base of its articular origin, excised and stalk ligated to prevent recurrence. At 1 year, there were no signs of recurrence and the patient was symptomatically free with no residual weakness. We, thus, report to you a rare cause of common peroneal nerve palsy—a proximal tibio-fibular joint “ganglion cyst”;a cause of foot drop which can be completely reversible if treated appropriately, its implications and thus, making its early diagnosis significant.展开更多
BACKGROUND Fat embolism syndrome(FES)is a rare disease characterized by pulmonary distress,neurologic symptoms,and petechial rash and seriously threatens human life and health.It is still neglected clinically because ...BACKGROUND Fat embolism syndrome(FES)is a rare disease characterized by pulmonary distress,neurologic symptoms,and petechial rash and seriously threatens human life and health.It is still neglected clinically because of the lack of verifiable diagnostic criteria and atypical clinical symptoms.No studies on FES with pulmonary embolism(PE)and tympanic membrane perforation have been reported to date.Here,we report a rare case of concomitant FES,PE and tympanic membrane perforation after surgery in a patient with a tibiofibular fracture.CASE SUMMARY A 39-year-old man presented with right lower extremity pain due to a car accident while driving a motorbike on the road.X-ray and computed tomography scans revealed a fracture of the right mid-shaft tibia and proximal fibula categorized as a type A2 fracture according to the AO classification.A successful minimally invasive operation was performed 3 d after the injury.Postoperatively,the patient developed sudden symptoms of respiratory distress and hearing loss.Early diagnosis was made,and supportive treatments were used at the early stage of FES.Seven days after surgery,he presented a clear recovery from respiratory symptoms.The outcome of fracture healing was excellent,and his hearing of the left ear was mildly impaired at the last follow-up of 4 mo.CONCLUSION Concomitant FES,PE and tympanic membrane perforation are very rare but represent potentially fatal complications of trauma or orthopedic surgery and present with predominantly pulmonary symptoms.Early diagnosis and treatment can reduce the mortality of FES,and prevention is better than a cure.展开更多
Introduction: Proximal tibiofibular joint osteoarthritis is a rare disease most commonly occurring in the presence of either systemic inflammatory conditions or severe knee osteoarthritis. Case Presentation: The autho...Introduction: Proximal tibiofibular joint osteoarthritis is a rare disease most commonly occurring in the presence of either systemic inflammatory conditions or severe knee osteoarthritis. Case Presentation: The authors present a case report of isolated bilateral tibiofibular arthrosis in an otherwise healthy 28-year-old female patient. The patient presented with complaints of lateral knee pain. Radiographs and magnetic resonance imaging (MRI) revealed bilateral tibiofibular joint osteoarthritis. Trauma, repetitive use injury, and rheumatologic causes were excluded. The patient’s pain was initially managed conservatively, but she subsequently underwent tibiofibular arthrodesis for progressive pain symptoms. We review in this report the current literature on tibiofibular joint osteoarthritis and its treatment. Conclusion: Isolated tibiofibular joint osteoarthritis is a rare condition that may progress and requires surgical treatment to achieve optimal clinical outcomes.展开更多
Objective： To study the influence of separation of distal tibiofibular syndesmosis on ankle joint and to compare various operative methods so as to find suitable stabilization for separated distal tibiofibular syndes...Objective： To study the influence of separation of distal tibiofibular syndesmosis on ankle joint and to compare various operative methods so as to find suitable stabilization for separated distal tibiofibular syndesmosis. Methods： From July 1997 to July 2002, we treated 87 patients （64 males and 23 females, aged 18-54 years） with separation of distal tibiofibular syndesmosis, among whom, 79 were combined with fracture of malleolus. Manipulative reduction, internal fixation with cancellous screws and external fixation with plaster support were performed on 37 patients, fixation with plate and screws for fibular fracture and fixation with cancellous screws for distal tibiofibular syndesmosis on 34 patients, and repair of the distal tibiofibular ligaments with tendon of peroneus Iongus, reduction of the separated distal tibiofibuiar syndesmosis, and fixation with cancellous screws on 16 patients. The ankle joint had been dorsiflexed for 30° when the distal tibiofibular syndesmosis was fixed with cancellous screws. And the cancellous screws were taken out at 8-10 weeks after operation. Results： These patients were followed up for at least two years. The curative effects were assessed according to the complaints of the patients and the contour, function and radiogram of the ankle joint： excellent in 55 patients （63 % ）, good in 18 patients （ 21% ）, and fair in 14 patients （16%）. Separation of distal tibiofibular syndesmosis recurred in 2 patients, who underwent a reoperation for repairing the distal tibiofibular ligaments with tendon of peroneus Iongus and recovered. One cancellous screw was broken off. No necrosis developed in the anterior skin of the ankle mortise. Conclusions ： Separation of distal tibiofibular syndesmosis can be treated with various reasonable operations. Repair with tendon of the peroneus Iongus can get excellent outcomes for complete separation of the distal tibiofibular syndesmosis.展开更多
Proximal tibiofibular instability is a rare condition for which treatment is poorly codified.A 21-year-old patient,a leisure sportswoman,presented a post-traumatic anterolateral instability of the proximal tibiofibula...Proximal tibiofibular instability is a rare condition for which treatment is poorly codified.A 21-year-old patient,a leisure sportswoman,presented a post-traumatic anterolateral instability of the proximal tibiofibular articulation without cartilage lesion.We propose an original surgical technique based on a review of the literature that combines an anatomical ligamentoplasty of the proximal tibiofibular joint and a proximal fibular diaphyseal osteotomy to reduce the distal tibiofibular mechanical stresses.This original technique allows a favorable evolution with recovery of professional and sports activities at 6 months.展开更多
BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report exp...BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain.Due to significant swelling and poor soft tissue quality,initial management involved external stabilization.Subsequently,needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury.The procedure,performed under spinal anesthesia and fluoroscopic control,included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button.Follow-up assessments showed significant improvement in pain levels,range of motion,and functional scores.At 26 weeks post-procedure,the patient achieved full range of motion and pain-free status.Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries,combining diagnostic and therapeutic capabilities with minimal invasiveness.CONCLUSION This technique may enhance clinical outcomes and reduce recovery times,warranting further investigation and integration into clinical practice.展开更多
文摘Disruption of the distal tibiofibular syndesmosis is frequently accompanied by rotational ankle fracture such as pronation-external rotation and rarely occurs without ankle fracture.In such injury,not only inadequately treated or misdiagnosed cases,but also correctly diagnosed cases can possibly result in a chronic pattern which is more troublesome to treat than an acute pattern.This paper reviews anatomical and biomechanical characteristics of the distal tibiofibular joint,the mechanism of chronic disruption of the distal tibiofibular syndesmosis,radiological and arthroscopic diagnosis,and surgical treatment.
文摘Although ganglion cysts occur frequently, their presence in the lower extremities is rare and they seldom cause peripheral nerve compression. There are enumerable case reports of intraneural ganglion involvement with the common peroneal nerve and its branches, the sural nerve, and the posterior tibial nerve but extraneural ganglion sciatic and common peroneal nerve palsy cases are quite rare. Our case, a 26 years old female patient presented with right leg tingling and radiating pain followed up gradually with progressive right sided foot drop. MRI diagnosed the lesion as a ganglion cyst and the EMG/NCV confirmed the level of compression at the right fibular head. The patient was electively operated with standard lateral approach and the ganglion cyst engulfing the common peroneal nerve was excised. The cyst was traced to the base of its articular origin, excised and stalk ligated to prevent recurrence. At 1 year, there were no signs of recurrence and the patient was symptomatically free with no residual weakness. We, thus, report to you a rare cause of common peroneal nerve palsy—a proximal tibio-fibular joint “ganglion cyst”;a cause of foot drop which can be completely reversible if treated appropriately, its implications and thus, making its early diagnosis significant.
基金The Subject Leadership Project of Shanghai Pudong New Area,No.PWRd2016-06the Featured Clinical Discipline Project of Shanghai Pudong,No.PWYts2018-03.
文摘BACKGROUND Fat embolism syndrome(FES)is a rare disease characterized by pulmonary distress,neurologic symptoms,and petechial rash and seriously threatens human life and health.It is still neglected clinically because of the lack of verifiable diagnostic criteria and atypical clinical symptoms.No studies on FES with pulmonary embolism(PE)and tympanic membrane perforation have been reported to date.Here,we report a rare case of concomitant FES,PE and tympanic membrane perforation after surgery in a patient with a tibiofibular fracture.CASE SUMMARY A 39-year-old man presented with right lower extremity pain due to a car accident while driving a motorbike on the road.X-ray and computed tomography scans revealed a fracture of the right mid-shaft tibia and proximal fibula categorized as a type A2 fracture according to the AO classification.A successful minimally invasive operation was performed 3 d after the injury.Postoperatively,the patient developed sudden symptoms of respiratory distress and hearing loss.Early diagnosis was made,and supportive treatments were used at the early stage of FES.Seven days after surgery,he presented a clear recovery from respiratory symptoms.The outcome of fracture healing was excellent,and his hearing of the left ear was mildly impaired at the last follow-up of 4 mo.CONCLUSION Concomitant FES,PE and tympanic membrane perforation are very rare but represent potentially fatal complications of trauma or orthopedic surgery and present with predominantly pulmonary symptoms.Early diagnosis and treatment can reduce the mortality of FES,and prevention is better than a cure.
文摘Introduction: Proximal tibiofibular joint osteoarthritis is a rare disease most commonly occurring in the presence of either systemic inflammatory conditions or severe knee osteoarthritis. Case Presentation: The authors present a case report of isolated bilateral tibiofibular arthrosis in an otherwise healthy 28-year-old female patient. The patient presented with complaints of lateral knee pain. Radiographs and magnetic resonance imaging (MRI) revealed bilateral tibiofibular joint osteoarthritis. Trauma, repetitive use injury, and rheumatologic causes were excluded. The patient’s pain was initially managed conservatively, but she subsequently underwent tibiofibular arthrodesis for progressive pain symptoms. We review in this report the current literature on tibiofibular joint osteoarthritis and its treatment. Conclusion: Isolated tibiofibular joint osteoarthritis is a rare condition that may progress and requires surgical treatment to achieve optimal clinical outcomes.
文摘Objective： To study the influence of separation of distal tibiofibular syndesmosis on ankle joint and to compare various operative methods so as to find suitable stabilization for separated distal tibiofibular syndesmosis. Methods： From July 1997 to July 2002, we treated 87 patients （64 males and 23 females, aged 18-54 years） with separation of distal tibiofibular syndesmosis, among whom, 79 were combined with fracture of malleolus. Manipulative reduction, internal fixation with cancellous screws and external fixation with plaster support were performed on 37 patients, fixation with plate and screws for fibular fracture and fixation with cancellous screws for distal tibiofibular syndesmosis on 34 patients, and repair of the distal tibiofibular ligaments with tendon of peroneus Iongus, reduction of the separated distal tibiofibuiar syndesmosis, and fixation with cancellous screws on 16 patients. The ankle joint had been dorsiflexed for 30° when the distal tibiofibular syndesmosis was fixed with cancellous screws. And the cancellous screws were taken out at 8-10 weeks after operation. Results： These patients were followed up for at least two years. The curative effects were assessed according to the complaints of the patients and the contour, function and radiogram of the ankle joint： excellent in 55 patients （63 % ）, good in 18 patients （ 21% ）, and fair in 14 patients （16%）. Separation of distal tibiofibular syndesmosis recurred in 2 patients, who underwent a reoperation for repairing the distal tibiofibular ligaments with tendon of peroneus Iongus and recovered. One cancellous screw was broken off. No necrosis developed in the anterior skin of the ankle mortise. Conclusions ： Separation of distal tibiofibular syndesmosis can be treated with various reasonable operations. Repair with tendon of the peroneus Iongus can get excellent outcomes for complete separation of the distal tibiofibular syndesmosis.
文摘Proximal tibiofibular instability is a rare condition for which treatment is poorly codified.A 21-year-old patient,a leisure sportswoman,presented a post-traumatic anterolateral instability of the proximal tibiofibular articulation without cartilage lesion.We propose an original surgical technique based on a review of the literature that combines an anatomical ligamentoplasty of the proximal tibiofibular joint and a proximal fibular diaphyseal osteotomy to reduce the distal tibiofibular mechanical stresses.This original technique allows a favorable evolution with recovery of professional and sports activities at 6 months.
文摘BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain.Due to significant swelling and poor soft tissue quality,initial management involved external stabilization.Subsequently,needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury.The procedure,performed under spinal anesthesia and fluoroscopic control,included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button.Follow-up assessments showed significant improvement in pain levels,range of motion,and functional scores.At 26 weeks post-procedure,the patient achieved full range of motion and pain-free status.Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries,combining diagnostic and therapeutic capabilities with minimal invasiveness.CONCLUSION This technique may enhance clinical outcomes and reduce recovery times,warranting further investigation and integration into clinical practice.
