Post-traumatic heterotopic ossification in front of the ankle joint for 23 years:A case report and review of literature

BACKGROUND Heterotopic ossification(HO)refers to the formation of new bone in non-skeletal tissues such as muscles,tendons or other soft tissues.Severe muscle and soft tissue injury often lead to the formation of HO.However,anterior HO of the ankle is rarely reported.CASE SUMMARY We report a patient with massive HO in front of the ankle joint for 23 years.In 1998,the patient was injured by a falling object on the right lower extremity,which gradually formed a massive heterotopic bone change in the right calf and dorsum of the foot.The patient did not develop gradual ankle function limitations until nearly 36 mo ago,and underwent resection of HO.Even after 23 years and resection of HO,the ankle joint was still able to move.CONCLUSION It is recommended that the orthopedist should be aware of HO and distinguish it from bone tumor.

THERAPEUTIC EFFECTS OF ELECTROACUPUNCTURE PLUS POINT-PENETRATION FOR CHRONIC ANKLE JOINT SPRAIN

Objective: To observe clinical therapeutic effects of electroacupuncture plus point-penetration for chronic ankle joint sprain. Methods: 76 patients were randomly divided into treatment group (n=43) and control group (n=33).In teatment group, penetration needling from Qiuxu (丘墟 GB 40) to Zhaohai (照海 KI 6) was performed, combined with electrical stimulation for 30 min. Patients of control group were ordered to take Antinfan (50 mg,b.i.d.),supplemented with local external application of Votalin cream (b.i.d.).After 14 treatments (two courses), the therapeutic effect was assessed. Results: Following two courses of treatment, of the 43 cases and 33 cases in treatment and control groups,33 (76.7%) and 15 (45.5%) were cured, 4 (9.3%) and 7 (21.2%) had marked improvement in their symptoms, 3 (7.0%) and 2 (6.1%) had improvement, and 3 (7.0%) and 9(27.3%) failed, with the effective rates being 93.0% and 72.7% respectively. The therapeutic effect of treatment group was significantly superior to that of control group (P<0.05). Conclusion: Penetrative needling plus EA is significantly superior to medication in relieving chronic ankle spain patient’s clinical symptoms and signs.

RESEARCH ON THE BIOMECHANICS OF ANKLE JOINT AFTER PARTIAL FIBULAECTOMY

patients undergoing upper-medial partial fibulaectomy were followed up for 1￣ 8 years.Clinical functions of bilateral ankle joints and plantor arches were evaluated and X-ray examination was carried out in these patients.Moving range and myodynamia of active muscle in bilateral ankle joints were evaluated by ankle joint function-evaluating instrument designed by the authors themselves and compared.The data from the examination demonstrated that partial fibulaectomy on the upper and middle part had no influence on the function of ankle joint.The authors suggest that it would be an applicable approach to take fibula as donor.

Design and simulation of a cable-pulley-based transmission for artificial ankle joints

In this paper, a mechanical transmission based on cable pulley is proposed for human-like actuation in the artificial ankle joints of human-scale. The anatomy articular characteristics of the human ankle is discussed for proper biomimetic inspiration in designing an accurate, efficient, and robust motion control of artificial ankle joint devices. The design procedure is presented through the inclusion of conceptual considerations and design details for an interactive solution of the transmission system. A mechanical design is elaborated for the ankle joint angular with pitch motion. A multi-body dynamic simulation model is elaborated accordingly and evaluated numerically in the ADAMS environment. Results of the numerical simulations are discussed to evaluate the dynamic performance of the proposed design solution and to investigate the feasibility of the proposed design in future applications for humanoid robots.

Dynamic Modeling and Performance Evaluation of a Novel Humanoid Ankle Joint

Aimed at the problems of design difficulty and weak kinematic performance caused by spherical joint,a novel PRC+PRCR+RR humanoid ankle joint based on the partially decoupled spherical parallel mechanism is proposed.According to screw theory,the degree of freedom and decoupling characteristics of this mechanism are analyzed.Based on Klein formula and virtual work principle,the kinematic expressions of each link and dynamic model are established.The correctness of the dynamic model is verified by combining the virtual prototype software and the ankle pose function obtained by gait planning and Fourier fitting.The workspace of this mechanism is mapped into a two-dimensional polar coordinate system with the azimuth and elevation angles of the spherical coordinate system as parameters.The motion/force transmission index and constraint index of this mechanism are evaluated and expressed in the workspace,showing this mechanism with excellent kinematic characteristics.

Application Effect of Chinese Medicine Rehabilitation in the Treatment of Adolescent Ankle Sports Injuries

Objective:To analyze the clinical effect of traditional Chinese medicine rehabilitation in treating adolescent ankle sports injuries.Methods:From December 2020 to December 2022,adolescent patients with ankle joint sports injuries admitted to our hospital were selected as observation objects,and 67 patients were divided into a control group(n=33,routine rehabilitation treatment)and an experimental group(n=34,traditional Chinese medicine rehabilitation treatment)according to the computer grouping method.Compare the treatment results.Results:(i)The treatment received in the experimental group had an efficacy of 94.11%,which was higher than that of the control group(75.75%),and statistical significance was established(P<0.05).(ii)Before treatment,there was no difference in ankle joint pain,ankle joint activity,and ankle joint function scores between the control group and the experimental group(P>0.05);after treatment,the ankle joint pain,ankle joint activity,and ankle joint function scores in the experimental group were significantly higher than those in the control group(P<0.05).(iii)The experimental group had higher scores on physiological function,physiological function,physical pain,general health status,energy,social function,emotional function,and mental health compared to the control group(P<0.05).Conclusion:Traditional Chinese medicine rehabilitation is effective in treating ankle injuries caused by sports in adolescents and improve their quality of life.Therefore,it should be popularized.

Observation on clinical application effect of ankle rehabilitation robot

Objective:The effect of ankle rehabilitation robot on joint movement of hemiplegic patients was studied and quantitatively evaluated.Methods 90 hemiplegic patients with lower limb dysfunction treated in our hospital from April 2017 to March 2019 were selected as subjects.The patients were randomly divided into two groups:control group(n=45)and observation group(n=45).The patients in the two groups received language training,physiotherapy,exercise therapy,spa,occupational therapy,massage and other comprehensive rehabilitation treatment,on the basis of which the observation group received the auxiliary intervention of ankle rehabilitation robot.The soft tissue compliance of the patients was evaluated by ankle metatarsal flexion moment before and after treatment,the metatarsal flexor tension was evaluated by modified Tardieu scale,and the clinical effect was evaluated by ankle active ankle dorsiflexion.Results After treatment,the ankle flexion angles(0°,10°,20°,30°)in the two groups were significantly lower than those in the control group(P<0.05).Results compared with before treatment,the ankle flexion angles(0°,10°,20°,30°)in the two groups were significantly lower than those in the control group(P<0.05).After treatment,the angle of R1 and R2 measured by modified Tardieu scale of ankle plantar flexor group increased significantly,and the difference of R2-R1 decreased significantly(P<0.05).The improvement degree of the observation group was significantly better than that of the control group(P<0.05).After treatment,the active ankle extension activity of the two groups was significantly higher than that before treatment(P<0.05),and the effective rate of the observation group was significantly higher than that of the observation group(P<0.05).Conclusion Auxiliary intervention with ankle rehabilitation robot system can effectively improve the compliance of ankle soft tissue in spastic hemiplegia,reduce the contracture of metatarsal flexor muscle and improve the disturbance of joint movement in a short time.At the same time,the degree of coordination and acceptance of patients and their families is high,which is an effective means to improve the therapeutic effect.

Extradural contralateral S1 nerve root transfer for spastic lower limb paralysis

The current study aims to ascertain the anatomical feasibility of transferring the contralateral S1 ventral root(VR)to the ipsilateral L5 VR for treating unilateral spastic lower limb paralysis.Six formalin-fixed(three males and three females)cadavers were used.The VR of the contralateral S1 was transferred to the VR of the ipsilateral L5.The sural nerve was selected as a bridge between the donor and recipient nerve.The number of axons,the cross-sectional areas and the pertinent distances between the donor and recipient nerves were measured.The extradural S1 VR and L5 VR could be separated based on anatomical markers of the dorsal root ganglion.The gross distance between the S1 nerve root and L5 nerve root was 31.31(±3.23)mm in the six cadavers,while that on the diffusion tensor imaging was 47.51(±3.23)mm in 60 patients without spinal diseases,and both distances were seperately greater than that between the outlet of S1 from the spinal cord and the ganglion.The numbers of axons in the S1 VRs and L5 VRs were 13414.20(±2890.30)and 10613.20(±2135.58),respectively.The cross-sectional areas of the S1 VR and L5 VR were 1.68(±0.26)mm2 and 1.08(±0.26)mm2,respectively.In conclusion,transfer of the contralateral S1 VR to the ipsilateral L5 VR may be an anatomically feasible treatment option for unilateral spastic lower limb paralysis.

Unusual manifestations of gastric inflammatory fibroid polyp in a child

AIM:Inflammatory fibroid polyp (IFP) is a rare benign lesion that may occur throughout the digestive tract.IFP is more commonly found in the antrum of the stomach in particular. It mostly affects adults at the average age of 60 years.These polyps are able to cause abdominal pain,gastrointestinal bleeding,intestinal obstruction or intussusception.In this paper we report a case of gastric TIP with unusual presenting features. METHODS:A child with gastric IFP was described and the literature was reviewed, RESULTS:A 4-year-old girl presented with fever for 2 months,arthralgia of knees and ankles,iron defidency anemia, and hypoalbuminemia.Her stool examination was positive for occult blood.The upper gastrointestinal study demonstrated a large Iobulated mass at the upper part of gastric body.Partial gastrectomy en blocwith this 5 cm×8 cm mass was subsequently performed.Pathological examination was consistent with IFP.Following the mass excision,her fever abruptly declined and disappeared together with anemia and arthralgia.She remained asymptomatic and the abdominal ultrasonography performed at the 24-month follow-up demonstrated no recurrence of the tumor. CONCLUSION:The etiopathogenesis of IFP still remains unclear,The presence of IFP throughout the gastrointestinal tract and its variable clinical appearances make it difficult to diagnose,The inflammatory symptoms found in this patient support the hypothesis of inflammatory benign lesions of IFP.

Design of the Pneumatic Pressure Smart Shoes for an Ankle-Assisted Exoskeleton

Ankle injury is one of the most common joint diseases that people experience during exercise.Most people have suffered ankle injuries at least once in their lives.The studies have shown that the ankle joint provides the most power and torques during the act of walking,compared to the knee and hip joints.This paper presents an ankle joint exoskeleton device,which is mainly used to provide assistance and protection to the human ankle joint with a pneumatic assist drive during walking.The pneumatic pressure smart shoes for this ankle exoskeleton were designed for detecting the human gaits to control the exoskeleton with certain supporting forces to the ankle joints at the appropriate timing.Each smart shoe has two sensors placed in between the wearable layer and the sole.The changes of the foot pressures were measured by the sensors for a microcontroller to control the exoskeleton.Two sets of experimental tests which were 2-month trials and gait selection were used to test the shoes.The experiments of 2-month trials were made to evaluate the stability of the shoes.The results showed that the shoes had no damages,no air leakage,and no malfunctions after the trials.The trials of gait selection were made to test the recognition rate which reached at 99.9%for the shoe system.The results showed that the design of the pneumatic smart shoes for the ankle-assisted exoskeleton met the requirements.

Functional Outcome of Pronation-External Rotation-Weber C Ankle Fractures with Supracollicular Medial Malleolar Fracture Treated with or without Syndesmotic Screws： A Retrospective Comparative Cohort Study

Background： In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or post-bony fixation during operation is seldom be reported in previous studies. The different strategies on stress test timing would exhibit opposite results within a type ofpronation-external rotation （PER） fractures with supracollicular medial malleolar （SMM） fractures. This study was designed to assess the 3-year ffmctional outcomes of the special PER fractures with or without a syndesmotic transfixation based on the results of two different intraoperative stress test strategies. Methods： This retrospective cohort study included 61 PER injury-Weber C ankle fractures combined with SMM fractures who were treated in Beijing Jishuitan Hospital between 2013 and 2014 and followed up for 3 years. Stress test was performed twice intraoperatively. A positive intraoperative stress test before bony fixation and a negative intraoperative stress test after bony fixation were found in these included patients. Twenty-nine patients （Group 1 ） were treated without a supplemental syndesmotie screw fixation, according to the negative intraoperative stress test alter bony fixation, while 32 patients （Group 2） were treated with an additional syndesmotic screw fixation based on the positive intraoperative stress test before bony fixation. The American Orthopaedic Foot and Ankle Society （AOFAS）Ankle-Hindfoot Scale and Visual Analog Scale （VAS） for pain scores were the main measurements of outcome. The statistical index of demographic data, fracture morphologic data, time interval of follow-up, AOFAS and VAS were recorded and assessed by SPSS 21.0 software through Fisher exact tests and oneway analysis of variance. The associations between the main outcomes and influential factors were evaluated by linear regression models. Results： We observed no difference in the distribution of age, sex, presence of associated posterior malleolus （PM）, fracture dislocation, and fixation of associated PM between two treatment groups. With the numbers available, no statistically significant association could be detected with regard to the AOFAS （Group 1 vs. Group 2, 96.72 ± 6.20 vs. 94.63 ± 8.26, F = 1.24, P = 0.27） and VAS （Group I vs. Group 2, 1.47 ± 2.14 vs. 0.72 ± 1.49, F = 2.44, P - 0.12） in association with two strategies. Conclusions： The present study indicates no difference to the use of the syndesmotic screw in terms of the ffinctional outcome between syndesmosis transfixation and no-fixation patients among PER-Weber C ankle fi＇acture patients with SMM fracture after 3-year ibllow-up. More attention should be paid to pre- and post-bony-fixation intraoperative stress tests and the morphology of medial malleoli fractures in ankle fractures.

Treatment of Ankle Sprain by Intradermal Acupuncture and Magnetic Therapy in 34 Cases

Treatment of 34 cases of Simple ankle sprain mainly by Ashi point and in cooperation with magnetic therapy, and Qiuxu (GB40), Shenmai(BL62), Jinmen (BL 63) and Pucan (BL 61) were added in the presence of strephenopodia sprain, Zhaohai (KI 6), Shuiquan (KI 5) and Taixi (KI 3) were added in the presence of strephexopodia sprain, the effective rate was 91.7%. Key Words Acupuncture-Moxibustion - Electromangetic Acupuncture - Ankle Joint - Sprains Author: Wang Hong-bin (1971-), male, acupuncturistTranslator: XIAO Yuan-chun

Clinical study of reconstructing the medial malleolus with free grafting of fibular head composite tendon bone flap

Objective： To explore new surgical procedure for repairing and reconstructing medial malleolus and soft tissue defect. Methods： According to the size of medial malleolus and composite soft tissue defect, vascular fibular bead composite tendon bone flap free wafting using anterior tibial recurrent vessel as the perforating branch was designed to reconstruct the medial malleolar saddle and triangular ligament, and composite back broadest muscle flap free grafting was designed to repair the medical malleolar wound surface. From January 2000 to December 2006, the technique was used in 5 male patients who were injured by machine or in traffic accidents, causing bone and soft tissue defect. The size of wound surface ranged from 19 cm×12 cm to 24 cm×12 cm. Results： The wound surface was healed at the first stage in 4 cases, and the other case had infection and was cured in 6 months with anti infection therapy. Postoperative foUow-ups from 6 months to 6 years showed that grafted bones and free cutaneous flaps were healed well, malleolar joints were stable, joint movement was normal, and the appearance was satisfactory. The overall outcome was good. Conclusion ： Fibular head composite tendon bone flap free grafting is effective for repairing medical malleolar defect.